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Abstract Prematurity is associated with lower exercise capacity, which relies on the integrity of the cardiovascular, pulmonary, and skeletal muscle systems. Our animal model mimicking prematurity-associated conditions showed altered muscle composition and atrophy in adulthood. This study aimed to compare muscle composition and strength in adults born preterm versus full-term controls. This observational cohort study recruited 55 adults born preterm, ≤ 29 weeks’ of gestation and 53 full-term controls who underwent musculoskeletal ultrasound imaging to assess morphology of the rectus femoris at rest and during a maximal voluntary contraction. Maximal voluntary contraction of the hands and legs were measured by manual dynamometry. In adults born preterm, there was lower muscle strength (handgrip: − 4.8 kg, 95% CI − 9.1, − 0.6; knee extensor: − 44.6 N/m, 95% CI − 63.4, − 25.8) and smaller muscle area (− 130 mm2, 95% CI − 207, − 53), which was more pronounced with a history of bronchopulmonary dysplasia. Muscle stiffness was increased in the preterm versus term group (0.4 m/s, 95% CI 0.04, 0.7). Prematurity is associated with alterations in skeletal muscle composition, area, and function in adulthood. These findings highlight the necessity to implement preventive and/or curative approaches to improve muscle development and function following preterm birth to enhance overall health in this population.

Differential equations are an important mathematical concept used to model processes in many disciplines. However, the literature shows that students experience many difficulties when studying this topic. We investigate the effect of using context while teaching differential equations on engineering students' ability to construct and interpret differential equations. We use a "pretest posttest quasi-experimental design" with an experimental and a control group. The experimental group is offered context-rich problems in which the construction of a differential equation and the interpretation of its solution in the given context is emphasized, while the control group is offered problems that mostly lack context and focus on procedural knowledge and skills only. The study shows that offering context-rich problems results in students being more skilled in the construction and interpretation of differential equations. Furthermore, it seems that the progress of students in these skills is not at the expense of procedural knowledge. According to our results, high performing students benefit the most from an approach that does not only focus on procedures. Finally, this approach seems to be effective in eliminating the misconception concerning the interpretation of the derivative in a differential equation as a change of amount instead of a rate of change.

Abstract ABCB4 is located at the canalicular membrane of hepatocytes and is responsible for the secretion of phosphatidylcholine into bile. Genetic variations of this transporter are correlated with rare cholestatic liver diseases, the most severe being progressive familial intrahepatic cholestasis type 3 (PFIC3). PFIC3 patients most often require liver transplantation. In this context of unmet medical need, we developed a high-content screening approach to identify small molecules able to correct ABCB4 molecular defects. Intracellularly-retained variants of ABCB4 were expressed in cell models and their maturation, cellular localization and function were analyzed after treatment with the molecules identified by high-content screening. In total, six hits were identified by high-content screening. Three of them were able to correct the maturation and canalicular localization of two distinct intracellularly-retained ABCB4 variants; one molecule was able to significantly restore the function of two ABCB4 variants. In addition, in silico molecular docking calculations suggest that the identified hits may interact with wild type ABCB4 residues involved in ATP binding/hydrolysis. Our results pave the way for their optimization in order to provide new drug candidates as potential alternative to liver transplantation for patients with severe forms of ABCB4-related diseases, including PFIC3.

Frost weathering is a key mechanism of rock failure in periglacial environments and landscape evolution. In high-alpine rock walls, freezing regimes are a combination of diurnal and sustained seasonal freeze–thaw regimes, and both influence frost cracking processes. Recent studies have tested the effectiveness of freeze–thaw cycles by measuring weathering proxies for frost damage in low-strength and in grain-supported pore space rocks, but detecting frost damage in low-porosity and crack-dominated alpine rocks is challenging due to small changes in these proxies that are close to the detection limit. Consequently, the assessment of frost weathering efficacy in alpine rocks may be flawed. In order to fully determine the effectiveness of both freezing regimes, freeze–thaw cycles and sustained freezing were simulated on low-porosity, high-strength Dachstein limestone with varying saturation. Frost-induced rock damage was uniquely quantified by combining X-ray computed microtomography (µCT), acoustic emission (AE) monitoring, and frost cracking modelling. To differentiate between potential mechanisms of rock damage, thermal- and ice-induced stresses were simulated and compared to AE activity. Our results underscore the significant impact of initial crack density on frost damage, with µCT scans revealing damage primarily through crack expansion. Discrepancies between AE signals and visible damage indicate the complexity of damage mechanisms. The study highlights frost cracking as the main driver of rock damage during freezing periods. Notably, damage is more severe during repeated freeze–thaw cycles compared to extended periods of freezing, a finding that diverges from field studies. This discrepancy could stem from limited water mobility due to low porosity or from the short duration of our experimental setup.

Summary: Antimicrobial resistance remains a persistent and pressing public health concern. Here, we describe the synthesis of original triazole-containing inhibitors targeting the DNA gyrase, a well-validated drug target for developing new antibiotics. Our compounds demonstrate potent antibacterial activity against various pathogenic bacteria, with notable potency against Mycobacterium tuberculosis (Mtb). Moreover, one hit, compound 10a, named BDM71403, was shown to be more potent in Mtb than the NBTI of reference, gepotidacin. Mechanistic enzymology assays reveal a competitive interaction of BDM71403 with fluoroquinolones within the Mtb gyrase cleavage core. High-resolution cryo-electron microscopy structural analysis provides detailed insights into the ternary complex formed by the Mtb gyrase, double-stranded DNA, and either BDM71403 or gepotidacin, providing a rational framework to understand the superior in vitro efficacy on Mtb. This study highlights the potential of triazole-based scaffolds as promising gyrase inhibitors, offering new avenues for drug development in the fight against antimicrobial resistance.

Abstract Structural fetal body MRI provides true 3D information required for volumetry of fetal organs. However, current clinical and research practice primarily relies on manual slice-wise segmentation of raw T2-weighted stacks, which is time consuming, subject to inter- and intra-observer bias and affected by motion-corruption. Furthermore, there are no existing standard guidelines defining a universal approach to parcellation of fetal organs. This work produces the first parcellation protocol of the fetal body organs for motion-corrected 3D fetal body MRI. It includes 10 organ ROIs relevant to fetal quantitative volumetry studies. We also introduce the first population-averaged T2w MRI atlas of the fetal body. The protocol was used as a basis for training of a neural network for automated organ segmentation. It showed robust performance for different gestational ages. This solution minimises the need for manual editing and significantly reduces time. The general feasibility of the proposed pipeline was also assessed by analysis of organ growth charts created from automated parcellations of 91 normal control 3T MRI datasets that showed expected increase in volumetry during 22–38 weeks gestational age range.

Abstract This study explores the potential of 3D Slice-to-Volume Registration (SVR) motion-corrected fetal MRI for craniofacial assessment, traditionally used only for fetal brain analysis. In addition, we present the first description of an automated pipeline based on 3D Attention UNet trained for 3D fetal MRI craniofacial segmentation, followed by surface refinement. Results of 3D printing of selected models are also presented. Qualitative analysis of multiplanar volumes, based on the SVR output and surface segmentations outputs, were assessed with computer and printed models, using standardised protocols that we developed for evaluating image quality and visibility of diagnostic craniofacial features. A test set of 25, postnatally confirmed, Trisomy 21 fetal cases (24–36 weeks gestational age), revealed that 3D reconstructed T2 SVR images provided 66–100% visibility of relevant craniofacial and head structures in the SVR output, and 20–100% and 60–90% anatomical visibility was seen for the baseline and refined 3D computer surface model outputs respectively. Furthermore, 12 of 25 cases, 48%, of refined surface models demonstrated good or excellent overall quality with a further 9 cases, 36%, demonstrating moderate quality to include facial, scalp and external ears. Additional 3D printing of 12 physical real-size models (20–36 weeks gestational age) revealed good/excellent overall quality in all cases and distinguishable features between healthy control cases and cases with confirmed anomalies, with only minor manual adjustments required before 3D printing. Despite varying image quality and data heterogeneity, 3D T2w SVR reconstructions and models provided sufficient resolution for the subjective characterisation of subtle craniofacial features. We also contributed a publicly accessible online 3D T2w MRI atlas of the fetal head, validated for accurate representation of normal fetal anatomy. Future research will focus on quantitative analysis, optimizing the pipeline, and exploring diagnostic, counselling, and educational applications in fetal craniofacial assessment.

In this work, in situ measurements of the radio frequency electromagnetic field exposure have been conducted for an indoor massive MIMO 5G base station operating at 26–28 GHz. Measurements were performed at six different positions (at distances between 9.94 and 14.32 m from the base station), of which four were in line-of-sight and two were in non-line-of-sight. A comparison was performed between the measurements conducted with an omnidirectional probe and with a horn antenna, for scenarios with and without a user equipment used to actively create an antenna traffic beam from the base station towards the measurement location. A maximum exposure of 171.9 mW/m2 was measured at a distance of 9.94 m from the base station. This is below 2% of the ICNIRP reference level. Moreover, the feasibility to measure the power per resource element of the Synchronization Signal Block - which can be used to extrapolate the maximum exposure level - with a conventional spectrum analyzer was shown by comparison with a network decoder.

Integrated STEM education is increasingly present in classrooms and in educational research, as it is proposed as a possible strategy to improve the problems of students’ lack of interest in scientific–technological disciplines. However, this increased interest in STEM education has been paralleled by a loss of cohesion in the interpretations of its theoretical basis and by an ongoing discussion on integrated STEM education’s foundations, making its understanding, translation into real projects, and evaluation difficult to undertake. Published articles defining a STEM theoretical framework have different descriptions, so the aim of this systematic literature review is to analyse these explanations and compare them with each other. Following the PRISMA 2020 guidelines, 27 articles of interest about STEM and STEAM education were obtained and analysed with a focus on the principles and characteristics described in the texts. After organising the information and analysing the similarities and differences in the principles and characteristics, we concluded that there is great consensus on the principles of “integration”, “real-world problems”, “inquiry”, “design”, and “teamwork”. Nonetheless, this review identifies areas of discussion regarding both the principles and their characteristics that invite further analysis to refine our understanding of what integrated STEM education should entail.

Background/Objectives: Janus kinase inhibitors (JAKis) belong to a new class of targeted oral drugs that have been added to the therapeutic arsenal for rheumatoid arthritis (RA). The aim of this study was to evaluate the efficacy and safety profiles of these four available molecules (tofacitinib, baricitinib, filgotinib, and upadacitinib) in real life. Methods: A retrospective, single-center observational study including all patients treated with JAKis for RA from 1 October 2017 to 1 December 2023. We assessed the maintenance rate at 24 months, which is an indirect reflection of the clinical and biological safety and efficacy profiles. Results: The 76 patients in our study were thus treated for the first time with anti-JAK, including 55 patients with baricitinib (BAR), 9 patients with tofacitinib (TOF), 4 patients with upadacitinib (UPA), and 8 patients with filgotinib (FIL). The majority of our patients had BAR introduced as the first intention. The therapeutic maintenance at 2 years for all our patients was 50%. The average maintenance duration was 8.6 months and was similar in all the groups. Of the 76 patients included in this study treated with Baricitinib (72.3%), 38 (50%) discontinued their treatment after two years of follow-up. Conclusions: Although this retrospective study is subject to various biases, it shows that the persistence rates of the four JAKi molecules in daily practice did not differ significantly, thus confirming the long-term efficacy of these drugs.

Acetate-producing Saccharomyces cerevisiae var. boulardii strains could exert improved effects on ulcerative colitis, which here, was preclinically evaluated in an acute dextran sodium sulphate induced model of colitis. Nine-week-old female mice were divided into 12 groups, receiving either drinking water or 2.75% dextran sodium sulphate for 7 days, combined with a daily gavage of various treatments with different levels of acetate accumulation: sham control (phosphate buffered saline, no acetate), non-probiotic control (Baker’s yeast, no acetate), probiotic control (Enterol®, transient acetate), and additionally several Saccharomyces cerevisiae var. boulardii strains with respectively no, high, and extra-high acetate accumulation. Disease activity was monitored daily, and feces samples were collected at different timepoints. On day 14, the mice were sacrificed, upon which blood and colonic tissue were collected for analysis. Disease activity in inflamed mice was lower when treated with the high-acetate-producing strain compared to sham and non-probiotic controls. The non-acetate-producing strain showed higher disease activity compared to the acetate-producing strains. Accordingly, higher histologic inflammation was observed in non- or transient-acetate-producing strains compared to the sham control, whereas this increase was not observed for high- and extra-high-acetate-producing strains upon induction of inflammation. These anti-inflammatory findings were confirmed by transcriptomic analysis of differentially expressed genes. Moreover, only the strain with the highest acetate production was superior in maintaining a stable gut microbial alpha-diversity upon inflammation. These findings support new possibilities for acetate-mediated management of inflammation in inflammatory bowel disease by administrating high-acetate-producing Saccharomyces cerevisae var. boulardii strains.

A low-cost, tri-axial 50 Hz magnetic field monitoring sensor was designed, calibrated and verified. The sensor was designed using off-the-shelf components and commercially available coils. It can measure 50 Hz magnetic fields originating from high-voltage power lines from 0.08 µT to 364 µT, divided into two measurement ranges. The sensor was calibrated both on-board and in-lab. The on-board calibration takes the circuit attenuation, noise and parasitic components into account. In the in-lab calibration, the output of the developed sensor is compared to the benchmark, a narrowband EHP-50. The sensor was then verified in situ under high-voltage power lines at two independent measurement locations. The measured field values during this validation were between 0.10 µT and 13.43 µT, which is in agreement with other reported measurement values under high-voltage power lines in literature. The results were compared to the benchmark, for which average deviations of 6.2% and 1.4% were found, at the two independent measurement locations. Furthermore, fields up to 113.3 µT were measured in a power distribution sub-station to ensure that both measurement ranges were verified. Our network, four active sensors in the field, had high uptimes of 96%, 82%, 81% and, 95% during a minimum 3-month interval. In total, over 6 million samples were gathered with field values that ranged from 0.08 µT to 45.48 µT. This suggests that the proposed solution can be used for this monitoring, although more extensive long-term testing with more sensors is required to confirm the uptime under multiple circumstances.

Background: Several retreatment strategies exist for rituximab in rheumatoid arthritis (RA). In some countries, reimbursement criteria require a loss of disease control for rituximab retreatment. Understanding the patients’ and rheumatologists’ perceptions regarding this retreatment strategy would be informative in identifying the optimal treatment administration schedule. Objectives: This study aimed to uncover patients’ and rheumatologists’ perceptions regarding retreatment strategies of rituximab. Design: Qualitative study – semi-structured interviews Methods: Patients with RA, treated with rituximab, and rheumatologists were invited to participate in a qualitative study consisting of individual, in-depth, semi-structured interviews. Interviews were analysed according to the Qualitative Analysis Guide of Leuven. Results: A total of 16 patients and 13 rheumatologists were interviewed. Benefits (e.g. decreased risk of overtreatment, cost savings and long-lasting effectiveness of rituximab) and barriers (e.g. fluctuating disease activity, slow mode of action and increased glucocorticoid use) of on-flare retreatment were identified. To effectively treat on-flare, flares must first be identified timely. Both stakeholder groups acknowledged that patients are capable of recognizing flares. However, the patient’s ability to discriminate between inflammatory and other types of pain was perceived as difficult. Furthermore, patients and rheumatologists stressed that patients must timely seek professional help in case of a flare, followed by a swift response from the rheumatologists. Remarkably, retreatment was approached in various ways among rheumatologists, and not always adhering strictly to the on-flare reimbursement criteria. Conclusion: This study revealed that both stakeholder groups perceived the heterogeneity in recognition of and reaction to a flare as important in influencing the effectiveness of the on-flare retreatment strategy. Moreover, this study identified the benefits and barriers of treating on-flare, which could be informative for daily practice decisions.

Conclusion: In cases of severe mediastinal adenopathy in a young patient, bacterial lymphadenitis should be considered in the differential diagnosis with lymphoma, germ cell tumor, granulomatosis with polyangiitis, sarcoidosis, histoplasmosis, and inflammatory myofibroblastic tumor.

IntroductionUltra-high field MR imaging offers marked gains in signal-to-noise ratio, spatial resolution, and contrast which translate to improved pathological and anatomical sensitivity. These benefits are particularly relevant for the neonatal brain which is rapidly developing and sensitive to injury. However, experience of imaging neonates at 7T has been limited due to regulatory, safety, and practical considerations. We aimed to establish a program for safely acquiring high resolution and contrast brain images from neonates on a 7T system.MethodsImages were acquired from 35 neonates on 44 occasions (median age 39 + 6 postmenstrual weeks, range 33 + 4 to 52 + 6; median body weight 2.93 kg, range 1.57 to 5.3 kg) over a median time of 49 mins 30 s. Peripheral body temperature and physiological measures were recorded throughout scanning. Acquired sequences included T2 weighted (TSE), Actual Flip angle Imaging (AFI), functional MRI (BOLD EPI), susceptibility weighted imaging (SWI), and MR spectroscopy (STEAM).ResultsThere was no significant difference between temperature before and after scanning (p = 0.76) and image quality assessment compared favorably to state-of-the-art 3T acquisitions. Anatomical imaging demonstrated excellent sensitivity to structures which are typically hard to visualize at lower field strengths including the hippocampus, cerebellum, and vasculature. Images were also acquired with contrast mechanisms which are enhanced at ultra-high field including susceptibility weighted imaging, functional MRI, and MR spectroscopy.DiscussionWe demonstrate safety and feasibility of imaging vulnerable neonates at ultra-high field and highlight the untapped potential for providing important new insights into brain development and pathological processes during this critical phase of early life.

Activity induced transcription factor ΔFosB plays a key role in different CNS disorders including epilepsy, Alzheimer’s disease, and addiction. Recent findings suggest that ΔFosB drives cognitive deficits in epilepsy and together with the emergence of small molecule inhibitors of ΔFosB activity makes it an interesting therapeutic target. However, whether ΔFosB contributes to pathophysiology or provides protection in drug-resistant epilepsy is still unclear. In this study, ΔFosB was specifically downregulated by delivering AAV-shRNA into the hippocampus of chronically epileptic mice using the drug-resistant pilocarpine model of mesial temporal epilepsy (mTLE). Immunohistochemistry analyses showed that prolonged downregulation of ΔFosB led to exacerbation of neuroinflammatory markers of astrogliosis and microgliosis, loss of mossy fibers, and hippocampal granule cell dispersion. Furthermore, prolonged inhibition of ΔFosB using a ΔJunD construct to block ΔFosB signaling in a mouse model of Alzheimer’s disease, that exhibits spontaneous recurrent seizures, led to similar findings, with increased neuroinflammation and decreased NPY expression in mossy fibers. Together, these data suggest that seizure-induced ΔFosB, regardless of seizure-etiology, is part of a homeostatic mechanism that protects the epileptic brain from further deterioration.

Commercial, high-tech upper limb prostheses offer a lot of functionality and are equipped with high-grade control mechanisms. However, they are relatively expensive and are not accessible to the majority of amputees. Therefore, more affordable, accessible, open-source, and 3D-printable alternatives are being developed. A commonly proposed approach to control these prostheses is to use bio-potentials generated by skeletal muscles, which can be measured using surface electromyography (sEMG). However, this control mechanism either lacks accuracy when a single sEMG sensor is used or involves the use of wires to connect to an array of multiple nodes, which hinders patients’ movements. In order to mitigate these issues, we have developed a circular, wireless s-EMG array that is able to collect sEMG potentials on an array of electrodes that can be spread (not) uniformly around the circumference of a patient’s arm. The modular sEMG system is combined with a Bluetooth Low Energy System on Chip, motion sensors, and a battery. We have benchmarked this system with a commercial, wired, state-of-the-art alternative and found an r = 0.98 (p < 0.01) Spearman correlation between the root-mean-squared (RMS) amplitude of sEMG measurements measured by both devices for the same set of 20 reference gestures, demonstrating that the system is accurate in measuring sEMG. Additionally, we have demonstrated that the RMS amplitudes of sEMG measurements between the different nodes within the array are uncorrelated, indicating that they contain independent information that can be used for higher accuracy in gesture recognition. We show this by training a random forest classifier that can distinguish between 6 gestures with an accuracy of 97%. This work is important for a large and growing group of amputees whose quality of life could be improved using this technology.

Background: Combined endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided tissue acquisition (EUS-TA) are accurate procedures for the diagnosis and staging of mediastinal lymph nodes (MLNs) in lung cancer. However, the respective contribution of separate and combined procedures in diagnosis and staging has not been fully studied. The aim of this study was to assess their respective performances. Methods: Patients with suspected malignant MLNs in lung cancer or recurrence identified by PET-CT who underwent combined EBUS-TBNA and EUS-TA were retrospectively reviewed. Results: A total of 141 patients underwent both procedures. Correct diagnosis was obtained in 82% with EBUS-TBNA, 91% with EUS-TA, and 94% with the combined procedure. The overall sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of EBUS-TBNA, EUS-TA, and the combined procedure for diagnosing malignancy were [75%, 100%, 100%, 58%], [87%, 100%, 100%, 75%], and [93%, 100%, 100%, 80%], respectively, with a significantly better sensitivity of the combined procedure (p < 0.0001). Staging (82/141 patients) was correctly assessed in 74% with EBUS-TBNA, 68% with EUS-TA, and 85% with the combined procedure. The overall sensitivity, specificity, PPV, and NPV of EBUS-TBNA, EUS-TA, and the combined procedure for lung cancer staging were [62%, 100%, 100%, 55%], [54%, 100%, 100%, 50%], and [79%, 100%, 100%, 68%], respectively, significantly better in terms of sensitivity for the combined procedure (p < 0.001). Conclusion: The combined EBUS-EUS approach in lung cancer patients showed better accuracy and sensitivity in diagnosis and staging when compared with EBUS-TBNA and EUS-TA alone.

• We examine different intrapreneurial behavioral components in order to build an intrapreneurship intervention. • We draw on interviews with 94 employees and a quasi-experimental research design of 190 employees in existing teams. • Our analyses show that intrapreneurial behavior in the intervention group is higher immediately after the intervention and three months later, compared to the control group. • Our theorizing demonstrates the positive contribution of using positive psychology interventions to develop intrapreneurship in employees. Intrapreneurial behavior is more and more valued in today's society. However, actually instigating this behavior in individuals is challenging. Drawing upon the theory of planned behavior, we investigate which behavioral components in employees help develop positive intrapreneurial norms, attitudes, perceived behavioral control, intentions and behavior. This work comprises two studies: a first qualitative study with 94 employees to determine twenty intrapreneurial behavioral components. Then, we create and test an intervention in a second study in ten existing teams with 90 employees undergoing a one-month intervention and 100 in a control group. Our results show that our intervention group indeed becomes better in intrapreneurial attitudes, perceived behavioral control, intention, and behavior, compared to the control group, immediately and three months after the intervention. This while contextual turbulence causes a decrease in the intrapreneurial behavior of the control group. To our knowledge, this paper is the first to create an intrapreneurship intervention, and to investigate behavioral components of intrapreneurial behavior. [ABSTRACT FROM AUTHOR]

There is increasing recognition in science and policy that the current nature and climate change crises are highly intertwined, and that these need to be jointly addressed. Within the United Nations Framework Convention on Climate Change (UNFCCC), the Race to Zero (R2Z) and the Race to Resilience (R2R) campaigns foster climate action by cities, regions, businesses, investors, and civil society organizations for mitigation and adaptation. The campaigns are part of UNFCCC-backed institutional arrangements linking intergovernmental climate governance with actions beyond national commitments to support the implementation of the Paris Agreement, also referred to as the Global Climate Action Agenda (GCAA). Both mobilization campaigns highlight and promote the contribution of nature to climate mitigation, adaptation, and resilience. Yet, the integration of nature in climate ambition is more complex than indicated in the calls to action. We here identify key areas of concern in the alignment of climate and biodiversity goals, discussing the biophysical and socio-ecological considerations relative to (i) practices for enhancing land-based and marine sinks to limit warming; (ii) the unpredictability of biodiversity dynamics under climate change; (iii) the spatial scale at which actions can be implemented; and (iv) the types of metrics that can be used for tracking progress. We provide recommendations for the two mobilization campaigns to integrate in their criteria and metrics frameworks to support effective and equitable actions that deliver for climate, but also for nature and people. We then make a call to action for transdisciplinary knowledge production and dissemination that strengthens science-policy interactions. [Display omitted] • Nature's contribution to climate mitigation and adaptation is increasingly recognized in science and policy. • The integration of nature in climate actions presents risks for climate, biodiversity and people. • Risks encompass bio-physical challenges, social trade offs, and equity concerns. • UN-backed mobilization campaigns can promote alignment goals for climate, nature, and people. • This article makes recommendations to strengthen standards, transparency, and accountability. [ABSTRACT FROM AUTHOR]

Sometimes non-neoplastic changes of the gastric mucosa mimic diffuse-type gastric carcinoma, specifically signet-ring cell adenocarcinoma. In fact, gastric epithelial cells undergoing signet-ring cell change have a cellular morphology that is almost identical to signet-ring cell adenocarcinoma, often leading to misdiagnosis. Accurate recognition of signet-ring cell change is essential to avoid overdiagnosis and overtreatment of signet-ring cell adenocarcinoma. Research on this topic is limited and clinicians lack formal diagnostic tools when signet-ring cells are detected in biopsy specimens. The aims of this study are 3-fold. Firstly, to increase the awareness of both clinicians and pathologists of this rare but highly significant entity. Secondly, to report 4 additional examples of signet-ring cell change and analyze them alongside signet-ring cell adenocarcinoma to compare their morphological and phenotypic features and their evolution over time. Finally, to highlight the potential utility of endoscopic resection to confirm the diagnosis. Cells in signet-ring cell change strongly express E-cadherin, show a wild-type p53 expression, and have a low Ki67 index. In contrast, cells in signet-ring cell adenocarcinoma strongly express p53, have high proliferation rates, and show either no or weak E-cadherin staining. Genetic analysis may be useful in identifying patients at risk of hereditary early diffuse gastric adenocarcinoma, which can mimic signet-ring cell change. [ABSTRACT FROM AUTHOR]

This article, published in the journal Endoscopy, discusses the application of a new endoscopic suturing device for the removal of gastric SELs (subepithelial lesions). The device consists of a disposable Needle Holder and auto-locking surgical thread, and it has been used to close parietal defects in different gastric positions. The article presents three cases of full-thickness resections of SELs or GISTs (gastrointestinal stromal tumors) at various sites in the stomach, where the parietal defect was successfully closed using the new hand suture system. The authors suggest that this device could have potential applications in other endoscopic digestive procedures. [Extracted from the article]