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This case report presents a novel digital technique for prosthetically driven orthodontic treatment. A 28-year-old patient who had undergone orthodontics as a teenager experienced a relapse and presented with esthetic concerns. The author utilized state-of-the-art software to create a virtual orthodontic-restorative treatment outcome with virtual restorations. This approach helped guide tooth movement, improve team communication, and optimize treatment outcomes while allowing for minimally invasive restorative treatment.

Gabapentinoids is a class of drug with analgesic, anxiolytic, and anticonvulsant properties and has a reported increase in prescription, use, and adverse outcomes. Regional studies are scant, and postmortem toxicological data may characterise patterns of regional use and inform local interventions. Characterising drug and non-drug-related deaths with gabapentinoid detection may also aid in toxicology interpretation. A 5-year retrospective study on all deaths admitted to the Gold Coast University Hospital under where toxicological analysis was performed. Of the gabapentinoids, only pregabalin was detected over the study period, and annual rates of detection did not differ significantly over the period (7.4-12.4%). In cases where pregabalin was detected, it was 15 times more likely to be a drug-related death. Drug-related deaths where pregabalin was detected have higher levels of pregabalin, are younger, and had a greater proportion of concurrent opioid detection. Postmortem detection of pregabalin was associated with drug-related deaths. Higher levels, younger decedents, and concurrent use of opioids were found in drug-related deaths. Public health interventions and regulated prescribing to target concurrent pregabalin and opioid use may address the burden of pregabalin drug-related deaths., (© 2023. The Author(s).)

Abstract: Agriculture encompasses a variety of activities that carry with them a variety of different risks. The unsafe use of vehicles, machinery, and tools as well as animal husbandry, working at heights, and exposure to chemical, biological, and weather events may result in the deaths of agricultural workers. Inexperienced operators and/or their inappropriate conduct may lead to avoidable fatalities. Forensic pathologists operating with the support of agricultural engineers or other professionals must evaluate the death scene, the case background and circumstances, the autopsy findings, and the toxicological data to establish the factors and dynamics responsible for such accidents and deaths.The aim of this review is to focus on the diagnostic approach required, by means of an interdisciplinary approach, to identify the cause of some typical agricultural fatalities, to confirm that death was accidental, and to help exclude the possibility of homicide or suicide., Competing Interests: Conflict of interest statement: None declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Acute necrotizing esophagitis (ANE), acute necrotising duodenitis (AND), and Wishnesky's lesions (WLs) are three peculiar upper gastrointestinal pathologies that can be seen in death from diabetic ketoacidosis (DKA). Amongst these three, AND has only been recently described. Morphologically, ANE and AND present as generalized black discoloration of the intestinal tract, and florid necrosis and inflammation. Whereas WLs are discrete black lesions in the stomach with necrosis and muted inflammation. We report a case of isolated AND with an unusual morphology not previously reported. A man in his 60s was found dead at home who died from pneumonia complicated by DKA. The gastrointestinal tract showed isolated patchy and discrete AND in which macroscopically resembled WLs, but microscopy resembled ANE with florid necrosis and acute inflammation. This case, together with the literature, documented AND can be macroscopically diffuse or discrete resembling ANE or WLs respectively but microscopically resemble ANE. Furthermore, the potential of these lesions being found in isolation in DKA raises the possibility of both general and local mechanisms playing a role on their morphology and presentation., (© 2024. The Author(s).)

As a part of a study of suicide in children aged 17 years and under in three centers-Hennepin County in the United States (US), Auckland in New Zealand (NZ), and South Australia in Australia (AUS) from 2008 to 2017 it was decided to characterize potential risk factors and to determine whether these differed by jurisdiction. Reviewed data included a history of psychiatric illness, symptoms prior to suicide, events preceding suicide, previous suicidal ideation or suicide attempts, and communication of suicidal intent. The most common events preceding suicide were arguments with family/friends and relationship issues; in addition depression with or without expressed suicidal ideation, self-harming behavior, sadness, distress, drug/substance abuse, and anorexia were documented. Suicidal intent was on occasion communicated via technological means. In 79.5% of cases in South Australia decedents had a previously diagnosed psychiatric illness, with 62% in Hennepin County. This compared to a much lower proportion of cases in Auckland (23.8%). Whether this reflects more limited access to psychiatric services or a reluctance to seek support and therapy in Auckland is unclear. It does, however, demonstrate that risk factors for child suicide are not uniform among communities and so extrapolation of data from one area to another may not be appropriate. Disturbingly parents/carers were not aware of the decedent's suicidal intent in 84-87.2% of cases., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Mild cognitive impairment (MCI) is a pre-clinical stage of Alzheimer's disease (AD). Understanding the transition probabilities across the disease continuum of AD, ranging from MCI to AD to Mortality is crucial for the economic modeling of AD and effective planning of future interventions and healthcare resource allocation decisions. This study uses the Multi-state Markov model to quantify the transition probabilities along the disease progression and specifically investigates medications as modifiable risk factors of AD associated with accelerated or decelerated transition times from MCI to AD, MCI to mortality, and AD to mortality., Methods: Individuals with MCI were identified from the National Alzheimer's Coordinating Center between September 2005 and May 2021. A three-state Markov model was postulated to model the disease progression among three states: MCI, AD, and mortality with adjustment for demographics, genetic characteristics, comorbidities and medications. Transition probabilities, the total length of stay in each state, and the hazard ratios of the use of medications for diabetes, hypertension, and hypercholesterolemia (the known modifiable risk factors of AD) were evaluated for these transitions., Results: 3,324 individuals with MCI were identified. The probability of developing AD after one year since the initial diagnosis of MCI is 14.9%. After approximately 6 years from the initial diagnosis of MCI, the probability of transitioning to AD increases to nearly 41.7% before experiencing a subsequent decline. The expected total lengths of stay were 5.38 (95% CI: 0.002-6.03) years at MCI state and 7.61 (95%CI: 0.002-8.88) years at AD state. Patients with active use of lipid-lowering agents were associated with significantly lower hazards of transitioning from MCI to AD (HR: 0.83, 95%CI:0.71-0.96), MCI to mortality (HR: 0.51, 95%CI:0.34-0.77), and AD to mortality (HR: 0.81, 95%CI:0.66-0.99)., Conclusions: Results suggest that lipid-lowering agents may confer a protective effect, delaying the onset of AD. Additionally, lipid-lowering agents indicate a favorable association with a longer survival time., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Abstract: Despite its severity, anaphylaxis carries a low mortality rate of less than 1%, making the cohort seen in the forensic pathology setting a small and unique subset of the majority of cases of anaphylaxis in the community. Clinically, cardiovascular disease has been recognized as a risk factor for fatal anaphylaxis; however, there is scant forensic pathology research investigating this risk factor, whereas autopsy textbooks emphasize physical respiratory changes seen in the broader clinical cohort. This 20-year retrospective study examined all fatal anaphylactic deaths in the state of Queensland, Australia, to document the underlying disease of the cases, tryptase levels, triggers, and postmortem findings. Our study found that cardiovascular disease was prevalent in 83.3% of cases of fatal anaphylaxis. Although asthma was prevalent in food-related fatal anaphylaxis (60%) in our cohort, it was poorly represented overall (28%), in contrast to clinical research. Additionally, only 43% of cases showed respiratory changes that were greater than mild. Our findings emphasize the difference between the clinical and postmortem anaphylaxis cohorts, and provide autopsy evidence of a potential role of cardiovascular disease in fatal anaphylaxis., Competing Interests: The authors report no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: The authors report no conflict of interest. Conflict of interest: None to declare.

Tobacco is a valuable crop, but its disease identification is rarely involved in existing works. In this work, we use few-shot learning (FSL) to identify abnormalities in tobacco. FSL is a solution for the data deficiency that has been an obstacle to using deep learning. However, weak feature representation caused by limited data is still a challenging issue in FSL. The weak feature representation leads to weak generalization and troubles in cross-domain. In this work, we propose a feature representation enhancement network (FREN) that enhances the feature representation through instance embedding and task adaptation. For instance embedding, global max pooling, and global average pooling are used together for adding more features, and Gaussian-like calibration is used for normalizing the feature distribution. For task adaptation, self-attention is adopted for task contextualization. Given the absence of publicly available data on tobacco, we created a tobacco leaf abnormality dataset (TLA), which includes 16 categories, two settings, and 1,430 images in total. In experiments, we use PlantVillage, which is the benchmark dataset for plant disease identification, to validate the superiority of FREN first. Subsequently, we use the proposed method and TLA to analyze and discuss the abnormality identification of tobacco. For the multi-symptom diseases that always have low accuracy, we propose a solution by dividing the samples into subcategories created by symptom. For the 10 categories of tomato in PlantVillage, the accuracy achieves 66.04% in 5-way, 1-shot tasks. For the two settings of the tobacco leaf abnormality dataset, the accuracies were achieved at 45.5% and 56.5%. By using the multisymptom solution, the best accuracy can be lifted to 60.7% in 16-way, 1-shot tasks and achieved at 81.8% in 16-way, 10-shot tasks. The results show that our method improves the performance greatly by enhancing feature representation, especially for tasks that contain categories with high similarity. The desensitization of data when crossing domains also validates that the FREN has a strong generalization ability., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Lin, Qiang, Tse, Tang and Pau.)

Abstract: Currently, traditional body length measurement at postmortem analysis involves processes, which are susceptible to human error and not reviewable or reproducible in case of data loss. Many facilities are now adopting routine postmortem computed tomography (PMCT) scanning, which provides a permanent and reviewable radiological record of body dimensions. Previous literature has validated the use of PMCT in estimating body and organ weights, but not in body length measurement. This retrospective study aimed to determine whether body length can be accurately and reliably measured when compared with traditional measurements in 50 consecutive adult cases. Our findings revealed that body length measured using PMCT had high intrarater and interrater reliability across different experience levels in raters (Pearson correlation coefficient and interclass correlation: >0.99, P < 0.01). Although body lengths measured using PMCT were significantly shorter (mean, -1.2 cm; 95% confidence interval, -1.75 to -0.65 cm; P < 0.05), it was deemed clinically insignificant and correlated well with those measured at postmortem examination (Pearson correlation coefficient and interclass correlation, >0.97; P < 0.01). While care will need to be taken to ensure the body in the body bag is in reasonable anatomical position for scanning purposes, overall, body length measured uniform PMCT is reliable, reproducible, and accurate., Competing Interests: The authors report no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: The objective of this study was to investigate how cleft surgeons classify palatal fistulas. We focused on three different anatomical locations (ie, hard palate, soft palate, junction hard/soft palate) to analyze agreement/disagreement at various anatomical locations., Design: Cross-sectional survey study., Participants: Participants in an international webinar that focused on palatal fistula treatment were included., Intervention: Participants were presented with a survey pre- and post-webinar., Main Outcomes: Frequency of used classification systems for classifying oronasal fistulas and the inter-rater reliability of the Pittsburgh classification system., Results: A total of 141 participants completed the questionnaires prior to the webinar and 109 participants completed the survey after the webinar. In total, four classification systems were used (ie, Pittsburgh, Pakistan Comprehensive Fistula Classification [PCFC], anatomical and 'other'). The Pittsburgh classification was the most commonly used system in all cases. However, Pittsburgh inter-rater reliability was low (κ = 0.136 pre-webinar, and κ = 0.174 post-webinar). Surprisingly, a substantial shift was observed from the anatomical to Pittsburgh classification after the webinar, indicating increased awareness of the usability of the Pittsburgh classification system., Conclusions: This study demonstrates a large heterogeneity with regards to the classification of cleft palate fistulas. Interestingly, a shift was observed from the anatomical to Pittsburgh classification after the webinar. However, the inter-rater reliability for using the Pittsburgh classification was low. Classifying palatal fistulas in a homogenous fashion could enhance comparison of primary palate repair and could improve treatment of palatal fistulas., 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.

Objective: To evaluate the features, anatomic accuracy, and educational value of a high-fidelity bilateral cleft lip simulator., Design: Evaluation of the simulator by expert cleft surgeons after performing a simulated bilateral cleft lip repair., Setting: The simulator was evaluated by the surgeons during the Latin American Craniofacial Association meeting., Participants: Eleven experienced cleft surgeons evaluated the simulator. The cleft surgeons were selected based on their availability during the meeting., Interventions: The participants performed a simulated bilateral cleft lip repair. They were each provided with a questionnaire assessing the simulator's features, realism and value as a training tool., Main Outcome Measure (s): The main outcome measure are the scores obtained from a Likert-type questionnaire assessing the simulators features, realism and value., Results: Overall, the surgeons agreed with the simulator's realism and anatomic accuracy (average score of 3.7 out of 5). Overall, the surgeons strongly agreed with the value of the simulator as a training tool (average score of 4.6 out of 5)., Conclusions: A high-fidelity bilateral cleft lip simulator was developed that is realistic and valuable as a training tool. The simulator provides a comprehensive training platform to gain hands-on experience in bilateral cleft lip repair before operating on real patients., 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.