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Introduction: India approved the “Covishield” vaccine for emergency use and began the first vaccination drive from January 16, 2021. As the new coronavirus disease-2019 (COVID-19) vaccine was developed within a short period, public acceptance for this new vaccine remains uncertain. Vaccine hesitancy remains an important challenge in the immunization against COVID-19. The aim of the current study was to assess different hesitancies, attitude, and beliefs about COVID-19 vaccine among health-care workers. Methods: A cross-sectional study was carried out among health-care professionals from 5th to January 15, just before the commencement of the first vaccination drive. All the participants were requested to fill out semi-structured pro forma containing following sections: (1) demographic details and (2) attitude and belief questionnaire. Following this, a lecture of around 45–60 min was conducted by trained professionals comprising of an education module. After the educational session, participants' willingness to take the vaccine was reassessed. Results: Totally, 598 participants participated in the study. Of these, 47% participants were not willing to take the vaccine. Participants with age

Background: Both hypertension (HTN) and tobacco addiction pose a threat to the health, environment, and socioeconomic status (SES) of the people. When tobacco use disorder exists in people with HTN, it hastens the disease progress and causes early complications. The present study aimed to study the knowledge and practice of tobacco addiction in patients with HTN and find out the correlates of knowledge and practice of tobacco addiction. Methods: A cross-sectional study was conducted for a period of one year in the Jamnagar District of Western Gujarat, India. Out of total 400 samples, 50% were collected from the five selected Community Health Centers (CHCs) by random sampling and the rest from non-communicable disease (NCD) clinics at the tertiary care hospital of the district. Findings: Most of the patients were in their fifties or above (67.0%), women (57.0%), and married (86.5%). Only 12.0% had awareness about the hazards of tobacco addiction and the prevalence of tobacco addiction was 11%. It was found that use of smokeless tobacco (SLT) among samples was the highest (72.7%) followed by dual consumption, i.e., SLT and smoking (20.5%). The frequency of consumption was ≥ 5 times/day in 54.5%, 70.4% were addicted for > 10 years, and only 15.9% had ever tried to quit tobacco while only 11.4% had successfully quit it. It was seen that those who were aged < 50 years, men, literates, employed, and those belonging to higher SES and urban residence had better knowledge of the health hazards. This was found to have significant statistical association. Conclusion: The results provide valuable insight into the tobacco addiction in patients with HTN on which non-pharmacological treatment of HTN can be based.

Introduction: Hypertension poses a global challenge in terms of morbidity and mortality. Worldwide prevalence of hypertension is over 40%. Management of hypertension targets blood pressure control to prevent disease complications. Though stress and hypertension are closely related, stress management is often overlooked in the treatment of hypertension. Aims: (1) To estimate the prevalence of stress in hypertensive patients and (2) to study the associated risk factors of stress and its implications in disease management. Materials and Methods: It was a hospital-based, cross-sectional study done in Western India for 1 year. Data were collected from 400 hypertensive patients attending the selected health institutions using a pretested questionnaire. Chi-square tests were done using Medcalc 10.4.8.0. Results: The prevalence of stress in hypertensive patients was found to be 84.3%. Only 2.4% of these patients sought help from any health professional for stress. The most common stressors found in the patients were financial dependence on others, living in rented house, having a daughter of marriageable age because of associated dowry, death of a loved one, sleep-related problem, and owing a debt among others. Significant statistical association (P < 0.05) of stress was observed with the type of family and socioeconomic status. A highly significant association (P < 0.001) of stress with religion and residential area (whether urban non-slum, slum, or rural) was observed. Stress in individuals leads to poorer compliance with treatment and blood pressure control. Conclusion: Coexistent stress should be diagnosed and managed in patients of hypertension for proper disease management and control.

Background: The metabolic syndrome (MetS) is a complex disorder and a major health concern in developing countries. Data on MetS in Indian population show multiplicity. There are no published reports about the prevalence of MetS in population of Saurashtra region, Gujarat. The aim of this study is to assess the prevalence of MetS and its components in adult population of this region. Methods: This cross-sectional observational study was carried out among 473 participants who attended free health checkup camps. Demographics, personal details along with anthropometric, clinical, and biochemical data were recorded. The MetS was diagnosed as per the definition provided by Joint Interim Statement 2009. Results: The overall prevalence of MetS among studied population was found to be 41.01% (females 44.21% and males 37.91%). Abdominal obesity (66.38%), low high-density lipoprotein-cholesterol (64.69%), and high blood pressure (40.59%) appeared as the most prevalent components. MetS showed a significant association with age, body mass index, total cholesterol, habit of chewing tobacco, and history of hypertension and hyperglycemia. Conclusion: The high prevalence of MetS shows that population of Saurashtra is at an increased risk of cardiovascular disease (CVD) and diabetes. This highlights the need for extensive diabetes and CVD prevention and control program in this region.

Introduction: Hypertension (HTN) is a chronic Cardiovascular Disease (CVD) characterised by persistently raised Blood Pressure (BP >140/90 mmHg), leading to various complications and currently causing the highest mortality, worldwide. The risks of morbidity and mortality related to HTN can be diminished by proper compliance to pharmacotherapy. Aim: To assess the compliance to treatment of HTN and to study its correlation with various sociodemographic variables, presence of other comorbidities, BP control, duration of disease and knowledge about duration of continuation of antihypertensives. Materials and Methods: A cross-sectional study was conducted in a district of Gujarat, India for a period of one year. A sample size of 400 was calculated. Hypertensive patients attending Non Communicable Disease (NCD) clinics at the tertiary care hospital and Community Health Centres (CHCs) of Jamnagar district, Gujarat, India selected by simple random sampling, formed the study population. Data were collected from patients using a predesigned, pretested and semistructured questionnaire. The data were analysed by MedCalc 10.4.8.0 software applying Chi-square test. Results: The rate of treatment compliance observed was 359 (89.8%). Among the non compliant patients, 28 (68.3%) had poor compliance whereas 13 (31.7%) had discontinued the treatment. Compliance to treatment showed highly significant association (p

Lipomatous tumours of salivary glands are very uncommonly diagnosed and reported tumours. Majority of these tumours present as painless masses which grow slowly over many years. On the histological grounds, they can be subclassified into ‘’monophasic’’ (lipoma component only) and ‘’biphasic’’ (lipoma component+epithelial component) tumours. A handful of biphasic tumours contain oncocytic component and they have been omitted from the WHO classification of salivary gland tumours so far and this has remained a matter of persistent confusion and controversy over many years. Other rare variants of monophasic tumours include fibrolipoma, sialolipoma, angiolipoma, sialadenosis and very rarely a liposarcoma can also occur in salivary glands. Pre-operative imaging can help in picking up the fatty component of the tumours and guide in accurate classification. FNAC may not be accurate in diagnosis of these tumours. We report a case of 45-year-old gentleman presenting with submandibular gland swelling for which submandibular gland excision was done. A final diagnosis of oncocytic lipoadenoma was made. We present this rare entity to add to the few cases reported to date and hence, to increase recognisation and understanding of these rare tumours, which may help in establishing a reproducible subclassification. We have discussed the pathological aspects with review of literature of this very rare entity.

Introduction: Idiopathic granulomatous mastitis (IGM) is a benign, chronic inflammatory disease with no effective treatment and high relapse rate. The pathophysiology is poorly understood. Tinosporin, an immunomodulator obtained from Tinospora cordifolia , is known to be useful in treating immune-mediated diseases. We report our experience of using Tinosporin for IGM and the effectiveness of this "steroid-free" regimen. Methods: We analysed the clinicopathological characteristics of patients diagnosed with IGM on histopathology during January 2018 and December 2022. Tinosporin tablet (500 mg Guduchi stem extract) was prescribed for 3-6 months; data were collected from electronic medical records and analysed in SPSS v-29. Results: Of 315 patients, 132 had complete clinical records. Median age was 39 years (25-77), and 107 (81.7%) were premenopausal. Seventy-eight (59.09%) had clinical suspicion of malignancy. On imaging, 84 (63.64%) were BIRADS 4/5 lesions. Empirical broad-spectrum antibiotics were prescribed to 101 patients. Tinosporin tablets were prescribed to 91 patients. Symptomatic response was seen in 72 (79.12%). Five patients did not achieve response, while 14 patients (15.38%) were lost to follow-up. At a median follow-up of 36 months (14-62 months), only 2 patients on Tinosporin had recurrence. None of the patients needed surgical intervention other than diagnostic biopsy or control of infection, and none received steroids. Conclusion: IGM is a benign, often self-limiting disorder. However, it mimics malignancy in 60% cases, and histology clinches the diagnosis. We report the efficacy of steroid-free management of IGM with immunomodulatory herbal origin phytopharmaceutical drug Tinosporin. It is safe, inexpensive and effective. Large volume excisions or mastectomies can be reserved for severe and refractory cases., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2025 Ankita Das Sheth et al. The Breast Journal published by John Wiley & Sons Ltd.)

Background: This study aimed to develop an automated algorithm to noninvasively distinguish gliomas from other intracranial pathologies, preventing misdiagnosis and ensuring accurate analysis before further glioma assessment., Methods: A cohort of 1280 patients with a variety of intracranial pathologies was included. It comprised 218 gliomas (mean age 54.76 ± 13.74 years; 136 males, 82 females), 514 patients with brain metastases (mean age 59.28 ± 12.36 years; 228 males, 286 females), 366 patients with inflammatory lesions (mean age 41.94 ± 14.57 years; 142 males, 224 females), 99 intracerebral hemorrhages (mean age 62.68 ± 16.64 years; 56 males, 43 females), and 83 meningiomas (mean age 63.99 ± 13.31 years; 25 males, 58 females). Radiomic features were extracted from fluid-attenuated inversion recovery (FLAIR), contrast-enhanced, and noncontrast T1-weighted MR sequences. Subcohorts, with 80% for training and 20% for testing, were established for model validation. Machine learning models, primarily XGBoost, were trained to distinguish gliomas from other pathologies., Results: The study demonstrated promising results in distinguishing gliomas from various intracranial pathologies. The best-performing model consistently achieved high area-under-the-curve (AUC) values, indicating strong discriminatory power across multiple distinctions, including gliomas versus metastases (AUC = 0.96), gliomas versus inflammatory lesions (AUC = 1.0), gliomas versus intracerebral hemorrhages (AUC = 0.99), gliomas versus meningiomas (AUC = 0.98). Additionally, across all these entities, gliomas had an AUC of 0.94., Conclusions: The study presents an automated approach that effectively distinguishes gliomas from common intracranial pathologies. This can serve as a quality control upstream to further artificial-intelligence-based genetic analysis of cerebral gliomas., Competing Interests: The authors declare no potential conflicts of interest., (© The Author(s) 2025. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.)

Background: Morphoea is a sclerosing disorder of skin and subcutaneous tissue. Paediatric morphoea shows increased prevalence of various auto-immune diseases, bone deformities, and systemic abnormalities. There is paucity of studies on various immunological, skeletal, and thyroid function abnormalities in paediatric morphoea., Aims and Objectives: To describe immunological, skeletal, and thyroid function abnormalities present in paediatric morphoea patients., Materials and Methods: This cross-sectional study was conducted from January 2021 to March 2023 in the Dermatology outpatient department in a tertiary care hospital. All paediatric morphoea patients were included in this study. All were subjected to detailed history, clinical examination, and investigations including complete blood count, serum IgE, anti-nuclear antibody, thyroid function tests, anti-thyroid peroxidase antibodies, and radiological investigations., Results: A total of 42 children were recruited, out of which 61.90% were females and 38.09% were males. The majority were in the age group of 4-8 years. The most common type of morphoea was encoup de sabre. Anaemia was present in 14.28% patients. Serum IgE levels were raised in 33.33% patients. Thyroid stimulating hormone was raised in 11.9% patients. 33.33% had raised anti-thyroid peroxidase levels. Anti-nuclear antibody titres and rheumatoid factor were raised in 7.14% and 4.76% patients, respectively. Magnetic resonance imaging brain revealed abnormalities in three patients as hyper-intensities in subcortical white matter., Conclusion: Morphoea in children can be associated with varied immunological, osteoarticular, and neurological abnormalities. This study highlights the multi-system involvement in morphoea and the need for larger data and well-designed therapeutic trials for generating evidence-based treatment of this potentially disfiguring disease., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Indian Journal of Dermatology.)

Nitroglycerin is a potent vasodilator in clinical use since the late 1800s. It functions as a prodrug that is bioactivated by formation of an enzyme-based thionitrate, E-Cys-NO 2 . This intermediate reportedly decomposes to release NO and NO 2 - but their relative yields remain controversial. Hence, we determined barriers for NO and NO 2 - production from the model thionitrate, CH 3 SNO 2 , using comprehensive high-level quantum chemistry calculations [CCSD(T)//MP2/aug-cc-pVTZ]. We find that the sulfenyl nitrite, CH 3 SONO, readily releases NO on (S)O-N bond homolysis but CH 3 SONO formation from CH 3 SNO 2 either by S-NO 2 bond homolysis or concerted rearrangement faces prohibitively high barriers (ΔH calc /ΔH ‡ calc  > 42 kcal/mol). Dramatically lower barriers (ΔH ‡ calc  ~ 17-21 kcal/mol) control NO 2 - release from CH 3 SNO 2 by gas-phase hydrolysis or nucleophilic attack by OH - or CH 3 S - on the sulfur atom within the C-S-NO 2 molecular plane. Moreover, attack by either anion along the S-NO 2 bond results in barrierless NO 2 - release (ΔH ‡ calc  ~ 0 kcal/mol) since a σ-hole (i.e., area of positive electrostatic potential) extends from this bond. Consistent with our high-level calculations, ALDH2 and GAPDH, enzymes implicated in nitroglycerin bioactivation via an E-Cys-NO 2 intermediate, catalyze mainly or exclusively NO 2 - release from the prodrug., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

The utilization of digital health in India is playing a crucial role in enhancing healthcare services by transitioning from the current inadequate public health structure to a more efficient and patient-centric system. Digital health includes various digital tools, such as electronic health records (EHRs), telemedicine, mobile health applications, health information exchange systems, and other technological advancements to improve access, efficiency, and quality of healthcare delivery. This study investigates the prospects and challenges encountered by the newly-digitized Maharashtra Emergency Medical Services (MEMS). Utilizing the 38,823 MEMS calls from November 2022, this study investigates the current status of emergency service delivery mechanisms in Maharashtra. Through spatial analyses, this study also explores the causes behind calls. The findings of the study show that calls for 108 ambulance services were distributed across the districts and had variable service delivery time periods. Current challenges to the system arise from various urban and healthcare infrastructure problems, as well as socio-cultural challenges. Implementation of the digitized MEMS system reveals key factors that influence the service's success, assisting the policymakers and health administrators in identifying and further improving the service.

Introduction Thoracolumbar fractures, particularly burst fractures, represent a significant health concern due to their prevalence and functional impact. This study evaluates the efficacy of short-segment posterior fixation with intermediate screw instrumentation in treating unstable thoracolumbar fractures. Methods A prospective study was conducted from July 2022 to December 2023, including 26 patients with traumatic thoracolumbar fractures. Surgical intervention was indicated for patients with a thoracolumbar injury classification and severity (TLICS) score >4. Functional outcomes were assessed using the visual analog scale (VAS), Oswestry Disability Index (ODI), and the American Spinal Injury Association (ASIA) grading system. Radiological outcomes, including the local kyphotic angle (LKA) and anterior vertebral body height ratio (AVBHR), were evaluated preoperatively, postoperatively, and at follow-ups. Results Significant improvements in functional and radiological parameters were observed over 24 weeks. The mean VAS score reduced from 7.50 ± 0.58 preoperatively to 1.42 ± 0.50 (p < 0.001), and the mean ODI improved from 42.23 ± 3.54 to 16.12 ± 3.09 (p < 0.001). Neurological improvements were seen in ASIA grades B-D, with no new deficits. Radiologically, the mean LKA improved from 19.73 ± 1.59° preoperatively to 8.46 ± 1.33° at 24 weeks (p < 0.001), and the AVBHR increased from 34.08 ± 2.25% to 86.64 ± 0.83% (p < 0.001). No implant failures were reported. Conclusion Short-segment fixation with intermediate screws provides effective stabilization and significant functional and radiological improvements in thoracolumbar fractures. It minimizes intraoperative morbidity and preserves motion segments, making it a viable alternative to long-segment fixation, particularly for non-complex fractures. Further randomized controlled trials are recommended to validate these findings., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethics Committee, Gandhi Medical College, Bhopal issued approval 32282/MC/IEC2022. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Jain et al.)

Aim: In India, 85% of organ donations are from living donors and 15% are from deceased donors. One-third of living donors were rejected because of ABO or HLA incompatibility. Kidney exchange transplantation (KET) is a cost-effective and legal strategy to increase living donor kidney transplantation (LDKT) by 25%-35%., Methods: We report our experience with 539 KET cases and the evolution of a single-centre program to increase the use of LDKT., Results: Between January 2000 and 13 March, 2024, 1382 deceased donor kidney transplantations and 5346 LDKT were performed at our centre, including 10% (n = 539) from KET. Of the 539 KET, 80.9% (n = 436) were ABO incompatible pairs, 11.1% (n = 60) were compatible pairs, and 8% (n = 43) were sensitized pairs. There were 75% 2-way (n = 2 × 202 = 404), 16.2% 3-way (n = 3 × 29 = 87), 3% 4-way (n = 4 × 4 = 16), 1.8% 5-way (n = 5 × 2 = 10), 2.2% 6-way (n = 6 × 2 = 12), and 1.8% 10-way KET (n = 10 × 1 = 10). Of the recipients 81.2% (n = 438) were male and 18.8% (n = 101) were female, while of the donors, 78.5% (n = 423) were female and 21.5% (n = 116) were male. All donors were near relatives; wives (54%, n = 291) and mothers (20%, n = 108) were the most common donors. At a median follow-up of 8.2 years, patient survival, death censored graft survival, acute rejection, and median serum creatinine levels of functioning grafts were 81.63% (n = 440), 91% (n = 494), 9.8% (n = 53) and 1.3 mg/dL respectively. We credited the success to maintaining a registry of incompatible pairs, high-volume LDKT programs, non-anonymous allocation and teamwork., Conclusion: This is the largest single-centre KET program in Asia. We report the challenges and solutions to replicate our success in other KET programs., (© 2024 Asian Pacific Society of Nephrology.)

Competing Interests: Competing interests: None declared.

Competing Interests: Competing interests: None declared.

Introduction: The New Jersey Kids Study (NJKS) is a transdisciplinary statewide initiative to understand influences on child health, development, and disease. We conducted a mixed-methods study of project planning teams to investigate team effectiveness and relationships between team dynamics and quality of deliverables., Methods: Ten theme-based working groups (WGs) (e.g., Neurodevelopment, Nutrition) informed protocol development and submitted final reports. WG members ( n = 79, 75%) completed questionnaires including de-identified demographic and professional information and a modified TeamSTEPPS Team Assessment Questionnaire (TAQ). Reviewers independently evaluated final reports using a standardized tool. We analyzed questionnaire results and final report assessments using linear regression and performed constant comparative qualitative analysis to identify central themes., Results: WG-level factors associated with greater team effectiveness included proportion of full professors ( β = 31.24, 95% CI 27.65-34.82), team size ( β = 0.81, 95% CI 0.70-0.92), and percent dedicated research effort ( β = 0.11, 95% CI 0.09-0.13); age distribution ( β = -2.67, 95% CI -3.00 to -2.38) and diversity of school affiliations ( β = -33.32, 95% CI -36.84 to -29.80) were inversely associated with team effectiveness. No factors were associated with final report assessments. Perceptions of overall initiative leadership were associated with expressed enthusiasm for future NJKS participation. Qualitative analyses of final reports yielded four themes related to team science practices: organization and process, collaboration, task delegation, and decision-making patterns., Conclusions: We identified several correlates of team effectiveness in a team science initiative's early planning phase. Extra effort may be needed to bridge differences in team members' backgrounds to enhance the effectiveness of diverse teams. This work also highlights leadership as an important component in future investigator engagement., Competing Interests: The authors have no conflicts of interest to declare., (© The Author(s) 2024.)

Background: Non-specific interstitial pneumonia (NSIP) is an interstitial lung disease that can result in end-stage fibrosis. We investigated the influence of body composition and pulmonary fat attenuation volume (CTpfav) on overall survival (OS) in NSIP patients., Methods: In this retrospective single-center study, 71 NSIP patients with a median age of 65 years (interquartile range 21.5), 39 females (55%), who had a computed tomography from August 2009 to February 2018, were included, of whom 38 (54%) died during follow-up. Body composition analysis was performed using an open-source nnU-Net-based framework. Features were combined into: Sarcopenia (muscle/bone); Fat (total adipose tissue/bone); Myosteatosis (inter-/intra-muscular adipose tissue/total adipose tissue); Mediastinal (mediastinal adipose tissue/bone); and Pulmonary fat index (CTpfav/lung volume). Kaplan-Meier analysis with a log-rank test and multivariate Cox regression were used for survival analyses., Results: Patients with a higher (> median) Sarcopenia and lower (< median) Mediastinal Fat index had a significantly better survival probability (2-year survival rate: 83% versus 71% for high versus low Sarcopenia index, p = 0.023; 83% versus 72% for low versus high Mediastinal fat index, p = 0.006). In univariate analysis, individuals with a higher Pulmonary fat index exhibited significantly worse survival probability (2-year survival rate: 61% versus 94% for high versus low, p = 0.003). Additionally, it was an independent risk predictor for death (hazard ratio 2.37, 95% confidence interval 1.03-5.48, p = 0.043)., Conclusion: Fully automated body composition analysis offers interesting perspectives in patients with NSIP. Pulmonary fat index was an independent predictor of OS., Relevance Statement: The Pulmonary fat index is an independent predictor of OS in patients with NSIP and demonstrates the potential of fully automated, deep-learning-driven body composition analysis as a biomarker for prognosis estimation., Key Points: This is the first study assessing the potential of CT-based body composition analysis in patients with non-specific interstitial pneumonia (NSIP). A single-center analysis of 71 patients with board-certified diagnosis of NSIP is presented Indices related to muscle, mediastinal fat, and pulmonary fat attenuation volume were significantly associated with survival at univariate analysis. CT pulmonary fat attenuation volume, normalized by lung volume, resulted as an independent predictor for death., (© 2024. The Author(s).)

We present a case of a male term neonate with lethargy, hypotonia, hypoventilation and severe encephalopathy. The infant had a history of two siblings who died in the neonatal period from unclear causes. The infant exhibited skin and hair abnormalities, including desquamation of the extremities, angular stomatitis, cheilitis, neonatal acne and thin, sparse hair. Additionally, the infant had a tall stature; long, slender fingers and toes; and facial dysmorphism characterised by a long, narrow face with increased interpalpebral distance. The condition deteriorated rapidly, and unfortunately, death occurred before a definitive diagnosis could be established. Tandem mass spectrometry suggested low methionine and clinical exome sequencing identified a nonsense mutation in the MTHFR gene., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

This study investigates the impact of carbohydrate accumulation in mangrove and halophytic plants on their response to abiotic stress. Using soil analysis and FT-IR spectroscopy, key species (Sueda nudiflora, Aeluropus lagopoides, Avicennia marina) were examined for seasonal changes in sugar content (reducing sugars, total soluble sugars, starch). The elevated carbohydrate levels may serve as an indication of the plant's ability to adapt to different environmental conditions throughout the year. This accumulation enables plants to adapt to variations in their environment, assuring their survival and functionality during periods of environmental fluctuation. Halophytic plants' sugar content peaked during the monsoon, suggesting biotic adaptations. The mangrove Avicennia marina had year-round sugar levels. PCA and Hierarchical Cluster Analysis revealed sugar accumulation trends across species and seasons. Partial Least Squares (PLS) analysis revealed correlations between soil characteristics and sugar content, suggesting plant-microbe interactions. K-means clustering and correlation analysis of FT-IR data revealed sugar composition and resource allocation trade-offs. These findings shed light on the role of carbohydrate metabolism in enabling coastal plants to endure stress. Gaining insight into these mechanisms can enhance sustainable agriculture in challenging environments and shed light on plant adaptations to evolving environmental conditions, especially biotic interactions., (© 2024. The Author(s).)

Determining the optimal loading schedule and measuring implant stability at different times are critical tasks. Numerous tools have been created to assess implant-bone stability as a sign of a well-treated implant. Thus, the objective of this cross-sectional study was to estimate the validity of the Osstell ISQ system for assessing implant stability. Osstell ISQ was used to complete implant stability registers for 60 implants across 18 patients. Two distinct SmartPegs (types I and II) were used to complete six measurements on each implant, or three measurements in a row with each transducer. In the 1st, 2nd, and 3rdmeasurements with SmartPegs I and II, the average ISQ was 71.36, 71.31, and 71.65, and 71.02, 71.58, and 71.76, respectively. For SmartPegs I and II, equivalent values or variations below three ISQ points were found in 46.3% and 58.6% of the cases, respectively. Both SmartPegs had an intraclass correlation coefficient of 0.96, and they also had repeatability and reproducibility of 0.96. An intra-class correlation coefficient analysis reveals nearly excellent repeatability and reproducibility for the RFA system Osstell ISQ. Measurements of Osstell ISQ have excellent repeatability., (© 2024 Biomedical Informatics.)

Purpose: Idiopathic pulmonary fibrosis (IPF) is the most common interstitial lung disease, with a median survival time of 2 to 5 years. The focus of this study is to establish a novel imaging biomarker., Materials and Methods: In this study, 79 patients (19% female) with a median age of 70 years were studied retrospectively. Fully automated body composition analysis (BCA) features (bone, muscle, total adipose tissue, intermuscular, and intramuscular adipose tissue) were combined into Sarcopenia, Fat, and Myosteatosis indices and compared between patients with a survival of more or less than 2 years. In addition, we divided the cohort at the median (high=≥ median, low=

Competing Interests: Competing interests: None declared.

Artificial intelligence (AI) stands at the threshold of revolutionizing clinical oncology, with considerable potential to improve early cancer detection and risk assessment, and to enable more accurate personalized treatment recommendations. However, a notable imbalance exists in the distribution of the benefits of AI, which disproportionately favour those living in specific geographical locations and in specific populations. In this Perspective, we discuss the need to foster the development of equitable AI tools that are both accurate in and accessible to a diverse range of patient populations, including those in low-income to middle-income countries. We also discuss some of the challenges and potential solutions in attaining equitable AI, including addressing the historically limited representation of diverse populations in existing clinical datasets and the use of inadequate clinical validation methods. Additionally, we focus on extant sources of inequity including the type of model approach (such as deep learning, and feature engineering-based methods), the implications of dataset curation strategies, the need for rigorous validation across a variety of populations and settings, and the risk of introducing contextual bias that comes with developing tools predominantly in high-income countries., (© 2024. Springer Nature Limited.)

Surgery exposes tumor tissue to severe hypoxia and mechanical stress leading to rapid gene expression changes in the tumor and its microenvironment, which remain poorly characterized. We biopsied tumor and adjacent normal tissues from patients with breast (n = 81) and head/neck squamous cancers (HNSC; n = 10) at the beginning (A), during (B), and end of surgery (C). Tumor/normal RNA from 46/81 patients with breast cancer was subjected to mRNA-Seq using Illumina short-read technology, and from nine patients with HNSC to whole-transcriptome microarray with Illumina BeadArray. Pathways and genes involved in 7 of 10 known cancer hallmarks, namely, tumor-promoting inflammation (TNF-A, NFK-B, IL18 pathways), activation of invasion and migration (various extracellular matrix-related pathways, cell migration), sustained proliferative signaling (K-Ras Signaling), evasion of growth suppressors (P53 signaling, regulation of cell death), deregulating cellular energetics (response to lipid, secreted factors, and adipogenesis), inducing angiogenesis (hypoxia signaling, myogenesis), and avoiding immune destruction (CTLA4 and PDL1) were significantly deregulated during surgical resection (time points A vs. B vs. C). These findings were validated using NanoString assays in independent pre/intra/post-operative breast cancer samples from 48 patients. In a comparison of gene expression data from biopsy (analogous to time point A) with surgical resection samples (analogous to time point C) from The Cancer Genome Atlas study, the top deregulated genes were the same as identified in our analysis, in five of the seven studied cancer types. This study suggests that surgical extirpation deregulates the hallmarks of cancer in primary tumors and adjacent normal tissue across different cancers., Implications: Surgery deregulates hallmarks of cancer in human tissue., (©2024 The Authors; Published by the American Association for Cancer Research.)

Purpose: The study aimed to develop the open-source body and organ analysis (BOA), a comprehensive computed tomography (CT) image segmentation algorithm with a focus on workflow integration., Methods: The BOA combines 2 segmentation algorithms: body composition analysis (BCA) and TotalSegmentator. The BCA was trained with the nnU-Net framework using a dataset including 300 CT examinations. The CTs were manually annotated with 11 semantic body regions: subcutaneous tissue, muscle, bone, abdominal cavity, thoracic cavity, glands, mediastinum, pericardium, breast implant, brain, and spinal cord. The models were trained using 5-fold cross-validation, and at inference time, an ensemble was used. Afterward, the segmentation efficiency was evaluated on a separate test set comprising 60 CT scans. In a postprocessing step, a tissue segmentation (muscle, subcutaneous adipose tissue, visceral adipose tissue, intermuscular adipose tissue, epicardial adipose tissue, and paracardial adipose tissue) is created by subclassifying the body regions. The BOA combines this algorithm and the open-source segmentation software TotalSegmentator to have an all-in-one comprehensive selection of segmentations. In addition, it integrates into clinical workflows as a DICOM node-triggered service using the open-source Orthanc research PACS (Picture Archiving and Communication System) server to make the automated segmentation algorithms available to clinicians. The BCA model's performance was evaluated using the Sørensen-Dice score. Finally, the segmentations from the 3 different tools (BCA, TotalSegmentator, and BOA) were compared by assessing the overall percentage of the segmented human body on a separate cohort of 150 whole-body CT scans., Results: The results showed that the BCA outperformed the previous publication, achieving a higher Sørensen-Dice score for the previously existing classes, including subcutaneous tissue (0.971 vs 0.962), muscle (0.959 vs 0.933), abdominal cavity (0.983 vs 0.973), thoracic cavity (0.982 vs 0.965), bone (0.961 vs 0.942), and an overall good segmentation efficiency for newly introduced classes: brain (0.985), breast implant (0.943), glands (0.766), mediastinum (0.880), pericardium (0.964), and spinal cord (0.896). All in all, it achieved a 0.935 average Sørensen-Dice score, which is comparable to the one of the TotalSegmentator (0.94). The TotalSegmentator had a mean voxel body coverage of 31% ± 6%, whereas BCA had a coverage of 75% ± 6% and BOA achieved 93% ± 2%., Conclusions: The open-source BOA merges different segmentation algorithms with a focus on workflow integration through DICOM node integration, offering a comprehensive body segmentation in CT images with a high coverage of the body volume., Competing Interests: Conflicts of interest and sources of funding: J.H. received financial support from the German Research Foundation (DFG) funded by the Clinician Scientist Academy of the University Hospital Essen (FU 356/12-2). The authors declare no other conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

This technique is employed for the simultaneous quantification of aspirin (ASP) and pantoprazole sodium in both pure powder form and formulations. The high performance liquid chromatography (HPLC) method uses a C-18 column (250 mm × 4.6 mm, 5 μm) with a mobile phase consisting of 0.05 M disodium hydrogen phosphate and methanol in a 40:60% v/v ratio. The flow rate is maintained at 1.0 mL/min. On a layer of silica gel 60F254 with an aluminum backing, the high performance thin layer chromatography (HPTLC) separation was carried out with ethyl acetate and methanol (8: 1.5 v/v) as the mobile phase. With a mean recovery of 100.54% and 99.55% for ASP and PNT, respectively, quantification was accomplished using the HPLC method with UV detection at 286 nm over the concentration range of 0.1-0.6 g/mL for PNT and 0.4-2.4 g/mL for ASP. With a mean recovery of 99.44% and 99.01% for ASP and PNT, respectively, quantification was achieved using the HPTLC method with UV detection at 298 nm over the concentration range of 400-2400 ng/spot for ASP and 100-600 ng/spot for PNT, respectively. The methods can be used for the simultaneous determination of ASP and PNT in pure powder form and formulations as they are simple, accurate and sensitive., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: Neoadjuvant chemotherapy (NACT) is routinely used in all cases of locally advanced breast cancer and some cases of early breast cancer. We previously reported a pathological complete response (pCR) rate of 8.3%. With the increasing use of taxanes and human epidermal growth factor receptor 2 (HER2)-directed NACT, we conducted this study to understand the current pCR rate and its determinants., Methods: A prospective database of breast cancer patients who underwent NACT followed by surgery between January and December 2017 was evaluated., Results: Of the 664 patients, 87.7% were cT3/T4, 91.6% were grade III, and 89.8% were node-positive at presentation (54.4% cN1, 35.4% cN2). The median age was 47 years; median pre-NACT clinical tumor size was 5.5 cm. Molecular subclassification was 30.3% hormone receptor positive (HR+) HER2-, 18.4% HR+HER2+, 14.9% HR-HER2+, and 31.6% triple negative (TN). Both anthracyclines and taxanes were given preoperatively in 31.2% patients whereas 58.5% of HER2 positive patients received HER2-targeted NACT. The overall pCR rate was 22.4% (149/664), 9.3% in HR+HER2-, 15.6% in HR+HER2+, 35.4% in HR-HER2+, and 33.4% in TN. On univariate analysis, duration of NACT ( P < 0.001), cN stage at presentation ( P = 0.022), HR status ( P < 0.001), and lymphovascular invasion ( P < 0.001) were associated with pCR. On logistic regression, HR negative status (Odds ratio [OR] 3.314, P < 0.001), longer duration of NACT (OR 2.332, P < 0.001), cN2 stage (OR 0.57, P = 0.012), and HER2 negativity (OR 1.583, P = 0.034) were significantly associated with pCR., Conclusion: Response to chemotherapy depends on molecular subtype and duration of NACT. A low rate of pCR in the HR+ subgroup of patients warrants reconsideration of neoadjuvant strategies., (Copyright © 2024 Copyright: © 2024 Indian Journal of Cancer.)

Ethnopharmacological Relevance: Withania somnifera (L.) Dunal; (Solanaceae), commonly known as Ashwagandha, is one of the most significant medicinal herbs in 'Ayurveda', a traditional Indian medicine used for centuries with evidence in scriptures. Ashwagandha was mentioned in old Ayurvedic medical literature such as Charaka Samhita and Sushruta Samhita for improving weight and strength, with multiple citations for internal and exterior usage in emaciation and nourishing the body. Ethnopharmacological evidence revealed that it was used to relieve inflammation, reduce abdominal swelling, as a mild purgative, and treat swollen glands. The root was regarded as a tonic, aphrodisiac, and emmenagogue in the Unani tradition of the Indian medicinal system. Further, Ashwagandha has been also described as an Ayurvedic medicinal plant in the Ayurvedic Pharmacopoeia of India extending informed therapeutic usage and formulations. Despite the widespread ethnopharmacological usage of Ashwagandha, clinical pharmacokinetic parameters are lacking in the literature; hence, the findings of this study will be relevant for calculating doses for future clinical evaluations of Ashwagandha root extract., Aim: This study aimed to develop a validated and highly sensitive bioanalytical method for quantifying withanosides and withanolides of the Ashwagandha root extract in human plasma to explore its bioaccessibility. Further to apply a developed method to perform pharmacokinetics of standardized Withania somnifera (L.) Dunal root extract (WSE; AgeVel®/Witholytin®) capsules in healthy human volunteers., Methods: A sensitive, reliable, and specific ultra-high pressure liquid chromatography-mass spectrometry (UHPLC-MS/MS) method was developed and validated for the simultaneous quantification of five major withanosides and withanolides (withanoside IV, withanoside V, withanolide A, withaferin A, and 12-deoxy-withastramonolide) in human plasma. Further for the study, eighteen healthy male volunteers (18-45 years) were enrolled in a non-randomized, open-label, single period, single treatment, clinical pharmacokinetic study and given a single dose (500 mg) of WSE (AgeVel®/Witholytin®) capsules containing not less than 7.5 mg of total withanolides under fasting condition. Later, pharmacokinetic profiles were assessed using the plasma concentration of each bioactive constituent Vs. time data., Results: For all five constituents, the bioanalytical method demonstrated high selectivity, specificity, and linearity. There was no carryover, and no matrix effect was observed. Furthermore, the inter-day and intra-day precision and accuracy results fulfilled the acceptance criteria. Upon oral administration of WSE capsules, C max was found to be 0.639 ± 0.211, 2.926 ± 1.317, 2.833 ± 0.981, and 5.498 ± 1.986 ng/mL for withanoside IV, withanolide A, withaferin A, and 12-deoxy-withastramonolide with T max of 1.639 ± 0.993, 1.361 ± 0.850, 0.903 ± 0.273, and 1.375 ± 0.510 h respectively. Further, withanoside V was also detected in plasma; but its concentration was found below LLOQ., Conclusion: The novel and first-time developed bioanalytical method was successfully applied for the quantification of five bio-active constituents in human volunteers following administration of WSE capsules, indicating that withanosides and withanolides were rapidly absorbed from the stomach, have high oral bioavailability, and an optimum half-life to produce significant pharmacological activity. Further, AgeVel®/Witholytin® was found safe and well tolerated after oral administration, with no adverse reaction observed at a 500 mg dose., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

Background: Primary central nervous system lymphomas (PCNSL) pose a challenge as they may mimic gliomas on magnetic resonance imaging (MRI) imaging, compelling precise differentiation for appropriate treatment. This study focuses on developing an automated MRI-based workflow to distinguish between PCNSL and gliomas., Methods: MRI examinations of 240 therapy-naive patients (141 males and 99 females, mean age: 55.16 years) with cerebral gliomas and PCNSLs (216 gliomas and 24 PCNSLs), each comprising a non-contrast T1-weighted, fluid-attenuated inversion recovery (FLAIR), and contrast-enhanced T1-weighted sequence were included in the study. HD-GLIO, a pre-trained segmentation network, was used to generate segmentations automatically. To validate the segmentation efficiency, 237 manual segmentations were prepared (213 gliomas and 24 PCNSLs). Subsequently, radiomics features were extracted following feature selection and training of an XGBoost algorithm for classification., Results: The segmentation models for gliomas and PCNSLs achieved a mean Sørensen-Dice coefficient of 0.82 and 0.80 for whole tumors, respectively. Three classification models were developed in this study to differentiate gliomas from PCNSLs. The first model differentiated PCNSLs from gliomas, with an area under the curve (AUC) of 0.99 (F1-score: 0.75). The second model discriminated between high-grade gliomas and PCNSLs with an AUC of 0.91 (F1-score: 0.6), and the third model differentiated between low-grade gliomas and PCNSLs with an AUC of 0.95 (F1-score: 0.89)., Conclusions: This study serves as a pilot investigation presenting an automated virtual biopsy workflow that distinguishes PCNSLs from cerebral gliomas. Prior to clinical use, it is necessary to validate the results in a prospective multicenter setting with a larger number of PCNSL patients., Competing Interests: The authors declare that there is no conflict of interest to disclose., (© The Author(s) 2024. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.)

Appropriate regulation of the inflammatory response is essential for survival. Interleukin-10 (IL-10), a well-known anti-inflammatory cytokine, plays a major role in controlling inflammation. In addition to immune cells, we previously demonstrated that the IL-10 receptor (IL-10R1) is expressed in dorsal root ganglion sensory neurons. There is emerging evidence that these sensory neurons contribute to immunoregulation, and we hypothesized that IL-10 signaling in dorsal root ganglion (DRG) neurons facilitates the regulation of the inflammatory response. We showed that mice that lack IL-10R1 specifically on advillin-positive neurons have exaggerated blood nitric oxide levels, spinal microglia activation, and cytokine upregulation in the spinal cord, liver, and gut compared to wild-type (WT) counterparts in response to systemic lipopolysaccharide (LPS) injection. Lack of IL-10R1 in DRG and trigeminal ganglion (TG) neurons also increased circulating and DRG levels of proinflammatory C-C motif chemokine ligand 2 (CCL2). Interestingly, analysis of published scRNA-seq data revealed that Ccl2 and Il10ra are expressed by similar types of DRG neurons; nonpeptidergic P2X purinoceptor (P2X3R + ) neurons. In primary cultures of DRG neurons, we demonstrated that IL-10R1 inhibits the production of CCL2, but not that of the neuropeptides substance P and calcitonin-gene related peptide (CGRP). Furthermore, our data indicate that ablation of Transient receptor potential vanilloid (TRPV)1 + neurons does not impact the regulation of CCL2 production by IL-10. In conclusion, we showed that IL-10 binds to its receptor on sensory neurons to downregulate CCL2 and contribute to immunoregulation by reducing the attraction of immune cells by DRG neuron-derived CCL2. This is the first evidence that anti-inflammatory cytokines limit inflammation through direct binding to receptors on sensory neurons. Our data also add to the growing literature that sensory neurons have immunomodulatory functions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Available data on cost of cancer treatment, out-of-pocket payment and reimbursement are limited in India. We estimated the treatment costs, out-of-pocket payment, and reimbursement in a cohort of breast cancer patients who sought treatment at a publicly funded tertiary cancer care hospital in India., Methods: A prospective longitudinal study was conducted from June 2019 to March 2022 at Tata Memorial Centre (TMC), Mumbai. Data on expenditure during each visit of treatment was collected by a team of trained medical social workers. The primary outcome variables were total cost (TC) of treatment, out-of-pocket payment (OOP), and reimbursement. TC included cost incurred by breast cancer patients during treatment at TMC. OOP was defined as the total cost incurred at TMC less of reimbursement. Reimbursement was any form of financial assistance (cashless or repayment), including social health insurance, private health insurance, employee health schemes, and assistance from charitable trusts, received by the patients for breast cancer treatment., Findings: Of the 500 patients included in the study, 45 discontinued treatment (due to financial or other reasons) and 26 died during treatment. The mean TC of breast cancer treatment was ₹258,095/US$3531 (95% CI: 238,225, 277,934). Direct medical cost (MC) accounted for 56.3% of the TC. Systemic therapy costs (₹50,869/US$696) were higher than radiotherapy (₹33,483/US$458) and surgery costs (₹25,075/US$343). About 74.4% patients availed some form of financial assistance at TMC; 8% patients received full reimbursement. The mean OOP for breast cancer treatment was ₹186,461/US$2551 (95% CI: 167,666, 205,257), accounting for 72.2% of the TC. Social health insurance (SHI) had a reasonable coverage (33.1%), followed by charitable trusts (29.6%), employee health insurance (5.1%), private health insurance (4.4%) and 25.6% had no reimbursement. But SHI covered only 40.1% of the TC of treatment compared to private health insurance that covered as much as 57.1% of it. Both TC and OOP were higher for patients who were younger, belonged to rural areas, had a comorbidity, were diagnosed at an advanced stage, and were from outside Maharashtra., Interpretation: In India, the cost and OOP for breast cancer treatment are high and reimbursement for the treatment flows from multiple sources. Though many of the patients receive some form of reimbursement, it is insufficient to prevent high OOP. Hence both wider insurance coverage as well as higher cap of the insurance packages in the health insurance schemes is suggested. Allowing for the automatic inclusion of cancer treatment in SHI can mitigate the financial burden of cancer patients in India., Funding: This work was funded by an extramural grant from the Women's Cancer Initiative and the Nag Foundation and an intramural grant from the International Institute of Population Sciences, Mumbai., Competing Interests: The authors declare no conflict of interest., (© 2023 The Author(s).)

Study Design: Prospective, observational., Objectives: The aim of our study was to assess the amount of reduction in lean muscle mass (LMM) of multifidus muscle (MFM) between conventional open Transforaminal lumbar interbody fusion (CO-TLIF) as compared to Minimally invasive spine Transforaminal lumbar interbody fusion (MIS-TLIF)., Methods: This study was conducted between 2017 and 2020. It included 100 patients divided into two groups, 50 patients treated with CO-TLIF, 50 treated with MIS-TLIF. Only patients undergoing single level, primary lumbar fusion at L4-5 or L5-S1 level for degenerative pathologies were included. All patients were assessed by magnetic resonance imaging (MRI) scans 1-year post surgery. Measurements were performed using ImageJ image processing program., Results: Mean percentage reduction in LMM in CO-TLIF group was 45.52 ± 12.36% and MIS-TLIF group was 25.83 ± 9.64% [statistically significant (t = 8.78, P < .001)]. Mean percentage reduction in LMM on side of cage insertion was 39.63 ± 15.96% and opposite side was 31.40 ± 15.01% [statistically significant (t = 9.06, P < .001)]. Mean reduction of LMM among males was 29.38 ± 15.23% and females was 40.42 ± 12.67% [statistically significant (t = -3.95, P < .001)].We observed significant but weak degree of correlation between age and percentage reduction of LMM (r = .22, P = .028)., Conclusion: Mean reduction in LMM was greater in CO-TLIF group as compared to MIS-TLIF. There was greater reduction in LMM in females and on side of cage insertion. We also found greater reduction in LMM with increasing age in both groups., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Treatment of lymph node basins is prognostic and therapeutic for axillary lymph nodes (ALN) as well as internal mammary lymph nodes (IMLNs) in breast cancer. IMLNs can be the first echelon node for the inner/central quadrants of the breast. We evaluated the yield of IMLN dissection (IMLND) mainly in patients with inner and central tumors., Methods: IMLND was performed in 199 patients between 2000 and 2018, 127 of whom had tumors in the inner/central quadrants. Clinico-pathological data were retrieved from Electronic Medical Records (EMR)., Results: The median age was 50 (range: 24-81). Primary surgery was performed in 82 (41.2%), while 117 (58.8%) were operated post-chemotherapy. Overall, 124/199 (62.3%) had nodes identified in the specimen, more often in primary (61/82, 74.4%) than post-chemotherapy settings (63/117, 53.8%) ( P = 0.003). A median of 1 (average: 1.24, range: 0-7) lymph nodes was dissected, and 1 (average: 1.5, range: 1-4) was involved. IMLN was positive in 46/199 (23.1%) patients, not significantly different in primary (21/82, 25.6%) versus post-chemotherapy (25/117, 21.4%) settings ( P = 0.545). IMLN was involved in 44.8% of patients with ≥4 involved ALN and 8.2% with uninvolved ALN ( P < 0.001). In the absence of ALN involvement and <2cm pT size, 9% of patients had positive IMLN in inner/central quadrant tumors. In univariate analysis, ALN positivity ( P < 0.001), pT size ( P = 0.023), and grade ( P = 0.041) in primary and ALN involvement ( P = 0.011) in post-chemotherapy patients were associated with IMLN involvement. On logistic regression, tumor size (OR: 13.914, P = 0.017) and ALN involvement (OR: 11.400, P = 0.005) in primary surgery and ALN involvement (OR: 7.294, P = 0.003) in post-chemotherapy patients correlated with IMLN involvement., Conclusions: In inner/central quadrant tumors, IMLN is more likely involved with high ALN burden and tumor size >2 cm, whereas those with ≤2cm inner/central quadrant tumors and negative ALN have <10% probability of IMLN involvement., (Copyright © 2024 Copyright: © 2024 Indian Journal of Cancer.)

Abstract: Platelet demand management (PDM) is a resource-consuming task for physicians and transfusion managers of large hospitals. Inpatient numbers and institutional standards play significant roles in PDM. However, reliance on these factors alone commonly results in platelet shortages. Using data from multiple sources, we developed, validated, tested, and implemented a patient-specific approach to support PDM that uses a deep learning-based risk score to forecast platelet transfusions for each hospitalized patient in the next 24 hours. The models were developed using retrospective electronic health record data of 34 809 patients treated between 2017 and 2022. Static and time-dependent features included demographics, diagnoses, procedures, blood counts, past transfusions, hematotoxic medications, and hospitalization duration. Using an expanding window approach, we created a training and live-prediction pipeline with a 30-day input and 24-hour forecast. Hyperparameter tuning determined the best validation area under the precision-recall curve (AUC-PR) score for long short-term memory deep learning models, which were then tested on independent data sets from the same hospital. The model tailored for hematology and oncology patients exhibited the best performance (AUC-PR, 0.84; area under the receiver operating characteristic curve [ROC-AUC], 0.98), followed by a multispecialty model covering all other patients (AUC-PR, 0.73). The model specific to cardiothoracic surgery had the lowest performance (AUC-PR, 0.42), likely because of unexpected intrasurgery bleedings. To our knowledge, this is the first deep learning-based platelet transfusion predictor enabling individualized 24-hour risk assessments at high AUC-PR. Implemented as a decision-support system, deep-learning forecasts might improve patient care by detecting platelet demand earlier and preventing critical transfusion shortages., (© 2023 by The American Society of Hematology.)

The quality of emergency medical services remains a major public health issue in developing countries in terms of access, availability, or timely delivery, owing to high socio-economic and ethnic disparities. Particularly, the timeliness of EMS remains a drawback, leading to higher mortality and morbidity. The aim of the study is to assess the district-level differences and factors that influence ambulance travel time, as there was no study done in the Indian scenario. Sequential Explanatory Design was applied here, which involved a descriptive study and spatial analysis of the call volume and distribution to understand the operational challenges of MEMS, followed by in-depth interviews among medical officers and officials to explore the reasons for the challenges. The data, shared by the Department of Health, Government of Maharashtra, consisted of 38,823 records (emergency: 16,197 and hospital-to-hospital transfer: 22,626), including emergency and hospital-to-hospital transfer calls across 36 districts of Maharashtra for November 2022. Spatial analyses were performed to identify the districts with challenges of timeliness. The average ambulance response time (T) across the districts was reported at 134.5 min for emergency cases and 222.80 min for hospital-to-hospital transfer cases. The total ambulance response time, was classified as preparation time (t1:3.53 min for emergency, 3.69 min for hospital-to-hospital transfer), travel time from base to scene (t2: 23.15 min for emergency, 17.18 min for hospital-to-hospital transfer), time required at scene (t3: 12.12 min for emergency, 14.72 min for hospital-to-hospital transfer), travel time from scene to hospital (t4:39.41 min for emergency, 74.34 min for hospital-to-hospital transfer), patient handover time (t5: 10.85 min for emergency, 13.84 min for hospital-to-hospital transfer), and return from base to hospital (t6: 41.89 min for emergency, 94.72 min for hospital-to-hospital transfer). Multivariate linear regression was conducted to investigate the factors that influence ambulance travel time. The finding identifies that the ambulance travel time increased for the districts with lesser population density, lower road density, fewer hospitals, a higher district area served per ambulance, and a higher population served per ambulance. Additionally, socio-cultural reasons affecting health-seeking behaviour, early closing of healthcare centres, undercapacity and resource-deficit healthcare centres, and overloading of specialised tertiary hospitals were identified as determinants of delay in patient assessment and handover time in qualitative findings. A decisive and multi-sectoral approach is required to address the timeliness of EMS in the Indian context., (© 2023. The Author(s).)

Women with either breast cancer (BC) or ovarian cancer (OC) have a 1.5-2 times higher risk of developing the other. Discerning discrete primaries versus metastases from either can be challenging. Clinico-pathological and outcome details of patients diagnosed with both BC and OC from December 1994 to August 2018 were retrospectively evaluated at a single tertiary cancer centre. We report the pattern of presentation and recurrences with case-based illustrations. Out of 139 patients, presentation was BC-first in 66.2%, OC-first in 24.5% and synchronous cancers (SC) in 9.3% of women. The median age at diagnosis in BC-first, OC-first and SC was 42 years, 48 years and 49 years, respectively. The most common histological subtype was invasive breast carcinoma-no special type (74.8%) in BC and serous cystadenocarcinoma (81.3%) in OC. BC presented at an early stage in 67.6% while OC presented at an advanced stage in 48.2% of patients. Germline mutation results were available in 82% with 61.4% of the cohort exhibiting a mutation- BRCA1 mutation being the most common. The median time to development of second cancer was 77.4 months and 39.4 months in BC-first and OC-first, respectively. At a median follow-up of 9.47 years, disease-free survival was 32.6%, 32.4% and 30.8% in BC-first, OC-first and SC, respectively ( p  < 0.001). In hereditary breast and ovarian cancer, BC-first patients have a better prognosis while synchronous malignancies have worse oncological outcomes. Deaths are mainly due to OC progression. Appropriate surveillance and prophylactic intervention in young patients with breast cancer may improve overall outcomes., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© The Author(s), under exclusive licence to Indian Association of Surgical Oncology 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Histamine is a neuromodulator that affects gut motility and visceral sensitivity through intrinsic and extrinsic neural pathways, yet the mechanisms regulating histamine availability in these pathways remain poorly understood. Here, we show that enteric glia contribute to histamine clearance in the enteric nervous system (ENS) through their expression of the enzyme histamine N -methyltransferase (HNMT). Glial HNMT expression was initially assessed using immunolabeling and gene expression, and functionally tested using CRISPR-Cas9 to create a Cre-dependent conditional Hnmt ablation model targeting glia. Immunolabeling, calcium imaging, and visceromotor reflex recordings were used to assess the effects on ENS structure and visceral hypersensitivity. Immunolabeling and gene expression data show that enteric neurons and glia express HNMT. Deleting Hnmt in Sox10+ enteric glia increased glial histamine levels and altered visceromotor responses to colorectal distension in male mice, with no effect in females. Interestingly, deleting glial Hnmt protected males from histamine-driven visceral hypersensitivity. These data uncover a significant role for glial HNMT in histamine degradation in the gut, which impacts histamine-driven visceral hypersensitivity in a sex-dependent manner. Changes in the capacity of glia to clear histamines could play a role in the susceptibility to developing visceral pain in disorders of the gut-brain interaction.

Purpose: To report comorbidity burden in newly-diagnosed treatment-naïve breast cancer patients and its effect on survival., Methods: Prospective observational study in which demographic, comorbidity and outcome data from a consecutive cohort of patients diagnosed and treated between September 2019 to September 2021 were collected. Charlson Comorbidity Index (CCI) score was calculated for all and proportion of each comorbidity was determined at diagnosis (baseline), at conclusion and six-months post-treatment. Univariate and multivariate analysis was done for impact of various demographic and disease-related factors on the incidence of comorbidities as well as on progression free survival (PFS) and overall survival (OS)., Results: Out of five hundred patients who consented for the study, 416 patients completed planned treatment and only 206 patients had physical follow-up due to COVID-19 pandemic. Incidence of comorbidity at the three time-points was 24%, 32% and 26% respectively. The difference was significant compared to baseline at both the time-points (p<0.05). Hypertension and diabetes were the most common types (incidence 15%-21% and 12-18% respectively) of comorbidities. Advancing age, post-menopauusal status and not being married were significant factors for presence of comorbidities. Median follow-up was 27 months (95% CI 26.25-28.55 months). Presence of multiple comorbidities was a poor prognostic factor for both PFS (2-yr PFS 85% vs 77%) and OS (2-yr OS 89% vs 79%) (both p=0.04) but no such correlation for CCI score., Conclusion: Breast cancer treatment impacted incidence of comorbidities. Presence of multiple comorbidities had an adverse impact on survival. Hence, further research on treatment optimization is required in patients with substantial comorbidities.

Potatoes are consumed worldwide because of their high accessibility, low cost, taste, and diversity of cooking methods. The high carbohydrate content of potatoes masks the presence of -vitamins, polyphenols, minerals, amino acids, lectins and protein inhibitors in the minds of consumers. The consumption of potatoes faces challenges among health-conscious people. This review paper attempted to provide up-to-date information on new metabolites reported in potatoes that play role in disease prevention and overall human well-being. We tried to compile information on antidiabetic, antihypertensive, anticancer, antiobesity, antihyperlipidemic, and anti-inflammatory potential of potato along with role in improving gut health and satiety. In-vitro studies, human cell culture, and experimental animal and human clinical studies showed potatoes to exhibit a variety of health-enhancing properties. This article will not only popularize potato as a healthy food, but will also improve its use as a staple for the foreseeable future., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Importance: Patients with early breast cancer must choose between undergoing breast conservation surgery or mastectomy. This decision is often difficult as there are trade-offs between breast conservation and adverse effects, and women with higher decisional conflict have a harder time choosing the therapy that suits their preferences., Objective: To study the impact of a decision aid with a patient preference assessment tool for surgical decision-making on patients' decisional conflict scale (DCS) score., Design, Setting, and Participants: This 3-group randomized clinical trial was conducted between June 2017 and December 2019 at a single high-volume tertiary care cancer center in Mumbai, India. A research questionnaire comprising 16 questions answered on a Likert scale (from 1, strongly agree, to 5, strongly disagree) was used to measure DCS scores and other secondary psychological variables, with higher scores indicating more decisional conflict. The Navya Patient Preference Tool (Navya-PPT) was developed as a survey-based presentation of evidence in an adaptive, conjoint analysis-based module for and trade-offs between cosmesis, adverse effects of radiotherapy, and cost of mandatory radiation following breast-conserving surgery. Adult patients with histologically proven early breast cancer (cT1-2, N0-1) who were eligible for breast-conserving surgery as per clinicoradiological assessment were included. Those who were pregnant or unable to read the research questionnaire or who had bilateral breast cancer were excluded. Data were analyzed from January to June 2020., Interventions: Patients were randomized 1:1:1 to study groups: standard care including clinical explanation about surgery (control), standard care plus the Navya-PPT provided to the patient alone (solo group), and standard care plus the Navya-PPT provided to the patient and a caregiver (joint group)., Main Outcomes and Measures: The primary end point of the study was DCS score. The study was 80% powered with 2-sided α = .01 to detect an effect size of 0.25 measured by Cohen d, F test analysis of variance, and fixed effects., Results: A total of 245 female patients (median [range] age, 48 [23-76] years) were randomized (82 to control, 83 to the solo group, and 80 to the joint group). The median (range) pathological tumor size was 2.5 (0-6) cm. A total of 153 participants (62.4%) had pN0 disease, 185 (75.5%) were hormone receptor positive, 197 (80.4%) were human epidermal growth factor receptor 2 negative, 144 (58.6%) were of middle or lower socioeconomic status, and 114 (46.5%) had an education level lower than a college degree. DCS score was significantly reduced in the solo group compared with control (1.34 vs 1.66, respectively; Cohen d, 0.50; SD, 0.31; P < .001) and the joint group compared with control (1.31 vs 1.66, respectively; Cohen d, 0.54; SD, 0.31; P < .001)., Conclusions and Relevance: The results of this study demonstrated lower decisional conflict as measured by DCS score following use of the online, self-administered Navya-PPT among patients with early breast cancer choosing between breast-conserving surgery vs mastectomy., Trial Registration: Clinical Trials Registry of India Identifier: CTRI/2017/11/010480.

Background: Axillary lymph node (LN) positivity is an important prognostic factor in breast cancer. Almost 30% clinically node negative (cN0) early breast cancers have positive nodes on pathology, wherein an axillary dissection is done as a second stage surgery. Intra operative frozen section (FS) potentially avoids redo surgery., Materials and Methods: We performed a retrospective audit for the false negative rate of intraoperative FS, from 2014 to 2018. All cN0 women undergoing upfront surgery, who underwent low axillary sampling (LAS) with FS were included., Results: Of 22,854 breast cancer cases, 2230 underwent LAS, of which 877 were node positive. Intraoperative FS was negative in 1423/2230 (63.81%) cases, of which 71/1423 (4.98%) were false negative, and came positive on final histopathology report (HPR). These 71 women had a median of 5 nodes (mean 4.85) dissected on FS (range 1-12) with a median 1 (mean 1.3) node positive (range 1-6) on HPR. The sensitivity of FS was 91.89% (95% CI, 89.89-93.62), with a negative predictive value of 95.01% (95% CI, 93.84-95.97), accuracy of 96.73% (95% CI, 95.90-97.43) and false negative rate 4.98%. On logistic regression analysis, micrometastasis (Odds ratio (OR) 7.76, 95% CI, 3.49-17.25, P < .001) lobular histology (OR 2.50, 95% CI, 1.007-6.223, P = .04) and nodes dissected (OR 1.18, 95% CI, 1.07-1.30, P = .001) were associated with higher false negative FS, and extra nodal extension (OR 0.32, 95% CI, 0.18-0.57, P ≤ .001) with lower false negative FS., Conclusion: The high concordance between intraoperative FS and definitive histology, suggests it's routine use for Sentinel lymph node/LAS LN can help avoid a second surgery., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Polycystic ovarian syndrome (PCOS) is one of the most common reproductive endocrinological disorders affecting 6%-8% of women in reproductive years. An early liberal PCOS screening appears to be a cost-effective strategy, benefiting earlier diagnosis and intervention., Objectives: The objectives are to measure the prevalence of PCOS and factors associated with PCOS among young girl students of a University in Central Gujarat., Materials and Methods: All consenting girl medical students enrolled in MBBS curriculum during 2013-2017 were given a self-administered questionnaire (for signs and symptoms of PCOS), taking due prior permissions; during January 2018-June 2019. Using Rotterdam (2006) criteria, those who were screened for PCOS were subjected to abdominal ultrasonography (USG) and if required, laboratory investigations (random blood sugar, thyroid-stimulating hormone, and free testosterone). The proportion of young women having PCOS as per the Rotterdam and European Society for Human Reproduction and Embryology (EHSRE) Criteria are reported., Results: The study enrolled 308 girl medical students. More than one-tenth of the study participants (11.7%, 36/308) had confirmed PCOS (Rotterdam Criteria). As per the EHSRE criteria, 24/36 had classic PCOS, 11/36 had ovulatory phenotype, and 01/36 had the non-hyperandrogenic phenotype PCOS. USG was required in 123/308 (39%); of which 91 consented and 16/91 (18%) had conclusive PCOS. Twenty-three girls required laboratory investigations, of which two had abnormal values suggestive of PCOS. Irregular menses and hirsutism were significantly associated with the PCOS (P < 0.05)., Conclusion: The proportion of young medical students with PCOS was 12%. Irregular menses and hirsutism were significantly associated with PCOS., (Copyright © 2023 Copyright: © 2023 Indian Journal of Public Health.)

Purpose: Online prediction models that use known prognostic factors in breast cancer (BC) are routinely used to assist in decisions for adjuvant therapy. PREDICT Version 2.2 (P2.2) is one such online tool, which uses tumor size, lymph node involvement, grade, age, hormone receptor status, human epidermal growth factor receptor 2 (HER2) status, and Ki67. We performed an external validation in a retrospective cohort of patients treated at a tertiary center in India., Methods: Women with operable BC between 2008 and 2016 with nonmetastatic, T1-T2 invasive, and HER2 receptor-negative BC and with available 5-year overall survival (OS) data were selected. Median predicted 5-year OS rates were used to calculate predicted events for the whole cohort and subgroups. The chi-square test was used to evaluate the goodness of fit of the tool., Results: Of 11,760 cases registered between 2008 and 2016, 2,783 (23.66%) eligible patients with a median age of 50 (26-70) years and a median pT size of 2.5 (0.1-5) cm, 2,037 (73.19%) with grade 3 tumors, 1,172 (42.11%) with node-positive disease, 817 (29.35%) with triple-negative breast cancer, and 1,966 (70.64%) with HR-positive BC were included in the analysis. The observed 5-year OS and predicted 5-year OS in the whole cohort were 94.8% and 90.00%, respectively, with an absolute difference of 4.8% (95% CI, 3.417 to 6.198, P < .001). The observed 5-year OS and predicted 5-year OS were also different in various subgroups., Conclusion: PREDICT version 2.2 overestimated the number of deaths, with lower predicted 5-year OS compared with the observed value, in this retrospective Indian cohort. The reasons for this discrepancy could be differing biologic characteristics and possible selection bias in our cohort. We recommend a prospective validation of PREDICT in Indian patients and advocate caution in its use until such validation is achieved.

Objectives: Chikungunya is an arboviral illness, with patients presenting with fever, arthralgias, and myalgias. Outbreaks have occurred in tropical regions, and the virus is now endemic to many tropics, including South Asia, with India contributing a large part of the global burden. The presentation and long-term effects on transplant recipients are largely unknown., Materials and Methods: In this retrospective analytical study, we compared chikungunya infection in 44 kidney transplant recipients from multiple centers in India and 34 patients from the general population. Data were collected from medical records and patient recall., Results: Differences in presentation were remarkable between the 2 groups, with significantly lower incidence of musculoskeletal symptoms on presentation in transplant recipients compared with the general population. The incidence of acute graft dysfunction was 17.08% in transplant recipients, with return to baseline at the end of 1 month. Acute symptomatology resolved in transplant recipients within 1 month, and insignificant chronic symptoms were reported after 3 months., Conclusions: Chikungunya in kidney transplant recipients is markedly different from that of the general population, with significantly lower incidence of musculoskeletal symptoms such as arthralgias. The infection caused acute graft dysfunction, but no long-term sequelae were shown at the end of 1 year.

Nita S. Nair Chemotherapeutic agents used in the treatment of breast cancer (BC) adversely impact growing ovarian follicles and can induce permanent premature ovarian failure or reduce ovarian reserve in younger women. As treatments result in improved survival of BC patients, young survivors face quality of life (QOL) issues, including treatment-related infertility. We conducted a survey to evaluate awareness among patients regarding the impact of cancer-directed therapy on fertility and available options of fertility preservation (FP). We interviewed 350 women with BC under 40 years of age at the start of treatment, of which 321 (91.70%) were in varying stages of follow-up, 8 women (2.30%) were scheduled to start treatment, and 21 (6.00%) women were under treatment. All received chemotherapy or hormone therapy with or without ovarian suppression. Of the 350 women who responded to the survey, 321 (91.70%) women were on follow-up, 8 (2.30%) women were due to start treatment, and 21 (6%) women were on treatment. The median age at diagnosis was 35 years, with 12.9% of women aged less than 30 years, 15 (4.28%) were unmarried, 31 (8.85%) were nulliparous, and 98 (28%) had one child. Overall, 271 (77.42%) women were aware (at the start of treatment) of impact of therapy on fertility, but only 48/271(17.71%) women were aware of the options of FP. In this cohort, 94/350 (26.85%) women felt FP was a priority, 64/350 (18.28%) women perceived their family as incomplete, and 17/64 (26.56%) women were willing to consider invasive reproductive assistance (IRA). Reasons for refusal for IRA included cost, risk of relapse, and delay of treatment. There was an association between being unmarried ( p  = 0.00), having an incomplete family (0.00), considering more children ( p  = 0.00) and willingness to consider IRA. FP is a priority for women treated for BC and an important QOL domain that needs to be addressed at the start of treatment We found a high level of awareness of impact of cancer-directed therapy to fertility in this cohort, but low awareness and acceptance for options for FP., Competing Interests: Conflict of Interest None declared., (MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Background: We present FHIR-PYrate, a Python package to handle the full clinical data collection and extraction process. The software is to be plugged into a modern hospital domain, where electronic patient records are used to handle the entire patient's history. Most research institutes follow the same procedures to build study cohorts, but mainly in a non-standardized and repetitive way. As a result, researchers spend time writing boilerplate code, which could be used for more challenging tasks., Methods: The package can improve and simplify existing processes in the clinical research environment. It collects all needed functionalities into a straightforward interface that can be used to query a FHIR server, download imaging studies and filter clinical documents. The full capacity of the search mechanism of the FHIR REST API is available to the user, leading to a uniform querying process for all resources, thus simplifying the customization of each use case. Additionally, valuable features like parallelization and filtering are included to make it more performant., Results: As an exemplary practical application, the package can be used to analyze the prognostic significance of routine CT imaging and clinical data in breast cancer with tumor metastases in the lungs. In this example, the initial patient cohort is first collected using ICD-10 codes. For these patients, the survival information is also gathered. Some additional clinical data is retrieved, and CT scans of the thorax are downloaded. Finally, the survival analysis can be computed using a deep learning model with the CT scans, the TNM staging and positivity of relevant markers as input. This process may vary depending on the FHIR server and available clinical data, and can be customized to cover even more use cases., Conclusions: FHIR-PYrate opens up the possibility to quickly and easily retrieve FHIR data, download image data, and search medical documents for keywords within a Python package. With the demonstrated functionality, FHIR-PYrate opens an easy way to assemble research collectives automatically., (© 2023. The Author(s).)

Purpose: Preventing metastases by using perioperative interventions has not been adequately explored. Local anesthesia blocks voltage-gated sodium channels and thereby prevents activation of prometastatic pathways. We conducted an open-label, multicenter randomized trial to test the impact of presurgical, peritumoral infiltration of local anesthesia on disease-free survival (DFS)., Methods: Women with early breast cancer planned for upfront surgery without prior neoadjuvant treatment were randomly assigned to receive peritumoral injection of 0.5% lidocaine, 7-10 minutes before surgery (local anesthetics [LA] arm) or surgery without lidocaine (no LA arm). Random assignment was stratified by menopausal status, tumor size, and center. Participants received standard postoperative adjuvant treatment. Primary and secondary end points were DFS and overall survival (OS), respectively., Results: Excluding eligibility violations, 1,583 of 1,600 randomly assigned patients were included in this analysis (LA, 796; no LA, 804). At a median follow-up of 68 months, there were 255 DFS events (LA, 109; no LA, 146) and 189 deaths (LA, 79; no LA, 110). In LA and no LA arms, 5-year DFS rates were 86.6% and 82.6% (hazard ratio [HR], 0.74; 95% CI, 0.58 to 0.95; P = .017) and 5-year OS rates were 90.1% and 86.4%, respectively (HR, 0.71; 95% CI, 0.53 to 0.94; P = .019). The impact of LA was similar in subgroups defined by menopausal status, tumor size, nodal metastases, and hormone receptor and human epidermal growth factor receptor 2 status. Using competing risk analyses, in LA and no LA arms, 5-year cumulative incidence rates of locoregional recurrence were 3.4% and 4.5% (HR, 0.68; 95% CI, 0.41 to 1.11), and distant recurrence rates were 8.5% and 11.6%, respectively (HR, 0.73; 95% CI, 0.53 to 0.99). There were no adverse events because of lidocaine injection., Conclusion: Peritumoral injection of lidocaine before breast cancer surgery significantly increases DFS and OS. Altering events at the time of surgery can prevent metastases in early breast cancer (CTRI/2014/11/005228).[Media: see text].

Introduction: Glutamate excitotoxicity is causal in striatal neurodegeneration underlying motor dysfunction and cognitive deficits in Huntington's disease (HD). Excitatory amino acid transporter 2 (EAAT2), the predominant glutamate transporter accounting for >90% of glutamate transport, plays a key role in preventing excitotoxicity by clearing excess glutamate from the intrasynaptic cleft. Accordingly, EAAT2 has emerged as a promising therapeutic target for prevention of neuronal excitotoxicity underlying HD and other neurodegenerative diseases., Methods: We have previously designed novel EAAT2 positive allosteric modulator GT951, GTS467, and GTS551, with low nanomolar efficacy in glutamate uptake and favorable pharmacokinetic properties. In this study, we test the neuroprotective abilities of these novel EAAT2 activators in vivo using the robust Drosophila HD transgenic model expressing human huntingtin gene with expanded repeats (Htt128Q)., Results: All three compounds significantly restored motor function impaired under HD pathology over a wide dose range. Additionally, treatment with all three compounds significantly improved HD-associated olfactory associative learning and short-term memory defects, while GT951 and GTS551 also improved middle-term memory in low-performing group. Similarly, treatment with GT951 and GTS551 partially protected against early mortality observed in our HD model. Further, treatment with all three EAAT2 activators induced epigenetic expression of EAAT2 Drosophila homolog and several cognition-associated genes., Conclusion: Together, these results highlight the efficacy of GT951, GTS467 and GTS551 in treating motor and cognitive impairments under HD pathology and support their development for treatment of HD., 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 © 2023 Bhatnagar, Parmar, Barbieri, Bearoff, Elefant and Kortagere.)