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Tabitha Y Chan,1 Johann I Tang,1 Poh Wee Tan,1 Neill Roberts2 1Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore; 2Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK Abstract: Radiation therapy (RT) is essential in treating women with early stage breast cancer. Early stage node-negative breast cancer (ESNNBC) offers a good prognosis; hence, late effects of breast RT becomes increasingly important. Recent literature suggests a potential for an increase in cardiac and pulmonary events after RT. However, these studies have not taken into account the impact of newer and current RT techniques that are now available. Hence, this review aimed to evaluate the clinical evidence for each technique and determine the optimal radiation technique for ESNNBC treatment. Currently, six RT techniques are consistently used and studied: 1) prone positioning, 2) proton beam RT, 3) intensity-modulated RT, 4) breath-hold, 5) partial breast irradiation, and 6) intraoperative RT. These techniques show dosimetric promise. However, limited data on late cardiac and pulmonary events exist due to challenges in long-term follow-up. Moving forward, future studies are needed to validate the efficacy and clinical outcomes of these current techniques. Keywords: early stage, breast cancer, radiation technique, dosimetric

Tabitha Y Chan, Poh Wee Tan, Johann I Tang Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore Abstract: Whole breast external beam radiotherapy (WBEBRT) is commonly used as an essential arm in the treatment management of women with early-stage breast cancer. Dosimetry planning for conventional WBEBRT typically involves a pair of tangential fields. Advancement in radiation technology and techniques has the potential to improve treatment outcomes with clinically meaningful long-term benefits. However, this advancement must be balanced with safety and improved efficacy. Intensity-modulated radiation therapy (IMRT) is an advanced technique that shows promise in improving the planning process and radiation delivery. Early data on utilizing IMRT for WBEBRT demonstrate more homogenous dose distribution with reduction in organs at risk doses. This translates to toxicities reduction. The two common descriptors for IMRT are forward-planning “fields in field” and inverse planning. Unlike IMRT for other organs, the aim of IMRT for breast planning is to achieve dose homogeneity and not organ conformality. The aim of this paper was to evaluate whether IMRT is ready for prime time based on these three points: 1) workload impact, 2) the clinical impact on the patient’s quality of life, and 3) the appropriateness and applicability to clinical practice. Keywords: early-stage breast cancer, radiotherapy, intensity-modulated radiation therapy, workload impact, quality of life, clinical practice

Lily Kai Man Xu,1 Toby Yiu Bong Chan2,3 1Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada; 2Division of Ophthalmology, Department of Surgery, McMaster University, Waterloo Regional Campus, Kitchener-Waterloo, Ontario, Canada; 3Ocular Health Centre, Kitchener, Ontario, CanadaCorrespondence: Toby Yiu Bong Chan, McMaster University, Waterloo Regional Campus, Kitchener-Waterloo, Ontario, Canada, Tel +1 519 208 8104, Fax +1 519 208 8101, Email toby.yb.chan@gmail.comPurpose: After tube shunt surgery, many factors may contribute to insufficient filtration over time, prompting further intervention to achieve optimal intraocular pressure (IOP) control. This study explores whether ab interno XEN gel stent implantation could be a viable approach in eyes that need further IOP reduction after tube shunt surgery.Methods: This is a retrospective, single-surgeon case series on ab interno XEN45 gel stent implantation in eyes that had previous tube shunt surgery. Main outcome measures were IOP and number of glaucoma medications at the pre-operative visit, post-operative week (POW) 1, and post-operative month (POM) 1, 3, 6, and 12. Adverse events and further interventions were noted. Surgery outcome was qualified as absolute success (IOP ≤ 18mmHg or ≥ 20% IOP reduction without glaucoma medications), qualified success (IOP ≤ 18mmHg or ≥ 20% IOP reduction with glaucoma medications), or failure (IOP > 18mmHg and < 20% IOP reduction with maximum tolerated glaucoma medications).Results: 7 eyes from 6 patients were included in this study. IOP was reduced from 23.9 ± 5.3 mmHg (mean ± standard deviation) pre-operatively to 14.0 ± 5.3 mmHg at POM12 (p < 0.05). Number of glaucoma medications was reduced from 4.3 ± 1.3 pre-operatively to 1.6 ± 1.6 at POM12 (p < 0.05). Hypotony and choroidal effusion were noted in one case which resolved before POM1. Bleb needling was required in 3 of the 7 eyes (43%), with one eye requiring needling twice. By POM12, 2 of 7 eyes (29%) achieved absolute success, 4 eyes (57%) qualified success, and 1 eye (14%) was qualified as failure.Conclusion: Ab interno XEN gel stent can effectively reduce IOP and number of glaucoma medications after failed tube shunt surgery. Nonetheless, further interventions such as bleb needling may still be required to optimize IOP control.Keywords: glaucoma, MIGS, tube shunt, Ahmed glaucoma valve, Baerveldt glaucoma device, ab interno XEN implant

Kai Man Xu,1 Ryan Cho,1 Toby Yiu Bong Chan2,3 1Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada; 2Division of Ophthalmology, Department of Surgery, McMaster University, Waterloo Regional Campus, Kitchener-Waterloo, Ontario, Canada; 3Ocular Health Centre, Kitchener, Ontario, CanadaCorrespondence: Toby Yiu Bong Chan, Ocular Health Center, Unit 501, 31 Kingsbury Dr, Kitchener, Ontario, N2A0K5, Canada, Tel +1 519 208 8104, Fax +1 519 208 8101, Email toby.yb.chan@gmail.comPurpose: Studies comparing the two different formulations of bimatoprost, 0.03% and 0.01%, have shown similar efficacy, but a better adverse effect profile for bimatoprost 0.01% in patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT). This study assesses the efficacy and tolerability of switching from bimatoprost 0.01% to 0.03% in a patient population with broader spectrum of diagnoses in a real-world clinical setting.Design: Single-centre retrospective observational switch study.Methods: Selected patients were on initial topical therapy with bimatoprost 0.01% prior to switching to bimatoprost 0.03%. Intraocular pressure (IOP) was collected from their pre-switch visit, 6- and 12-week after switch. Paired two-sample t-test was performed to compare IOP at different time points versus baseline. Worsening of hyperemia and other adverse events after the switch were identified. Subgroup analysis was performed for POAG and OHT, secondary open-angle glaucoma (SOAG, including pseudoexfoliative and pigmentary glaucoma), normal tension glaucoma (NTG), and angle closure glaucoma (ACG).Results: The study population consisted of 248 eyes (143 patients). There was a significant mean IOP reduction of 1.0 ± 3.7 mmHg (p < 0.001, n = 248) from baseline to week-6 and 1.6 ± 4.0 mmHg (p < 0.001, n = 142) from baseline to week-12 after switch. The IOP reduction was statistically significant in patients with POAG and OHT (6-week: 1.0 ± 3.8 mmHg, n = 76; 12-week: 1.5 ± 4.1 mmHg, n = 49), ACG (6-week: 1.5 ± 4.1 mmHg, n = 72; 12-week: 2.3 ± 4.5 mmHg, n = 46), and NTG (6-week: 0.83 ± 2.5 mmHg, n = 42; 12-week: 1.12 ± 2.1 mmHg, n = 25). Patients with SOAG did not show statistically significant reduction in IOP at 6- or 12-week after switch. Forty-two (29%) of 143 patients experienced adverse events, with the most common being hyperemia (16%).Conclusion: Significant reduction in IOP could be seen after switching from bimatoprost 0.01% to bimatoprost 0.03% in various types of glaucoma except SOAG. Intolerance after switch may be experienced, though not in the majority of cases.Keywords: bimatoprost, intraocular pressure, conjunctival hyperemia, glaucoma, ocular hypertension

Purposes: Outcome prediction for out-of-hospital cardiac arrest (OHCA) is of medical, ethical, and socioeconomic importance. We hypothesized that blood ammonia may reflect tissue hypoxia in OHCA patients and conducted this study to evaluate the prognostic value of ammonia for the return of spontaneous circulation (ROSC). Methods: This prospective, observational study was conducted in a tertiary university hospital between January 2008 and December 2008. The subjects consisted of OHCA patients who were sent to the emergency department (ED). The primary outcome was ROSC. The prognostic values were calculated for ammonia levels and the partial pressure of ammonia (pNH(3)), and the results were depicted as a receiver operating characteristics curve with an area under the curve. Results: Among 119 patients enrolled in this study, 28 patients (23.5%) achieved ROSC. Ammonia levels and pNH(3) in the non-ROSC group were significantly higher than those in the ROSC group (167.0 μmol/L vs 80.0 μmol/L, P < .05; 2.61 × 10(-5) vs 1.67 × 10(-5) mm Hg, P < .05, respectively). The predictive capacity of area under the curve for ammonia and pNH(3) for non-ROSC was 0.85 (95% confidence interval, 0.75-0.95) and 0.73 (95% confidence interval, 0.61-0.84), respectively. The multivariate analysis confirmed that ammonia and pNH(3) are independent predictors of non-ROSC. The prognostic value of ammonia was better than that of pNH(3). The cutoff level for ammonia of 84 μmol/L was 94.5% sensitive and 75.0% specific for predicting non-ROSC with a diagnostic accuracy of 89.9%. Conclusions: Hyperammonemia on ED arrival is independently predictive of non-ROSC for OHCA patients. The findings may offer useful information for clinical management. [ABSTRACT FROM AUTHOR]

Background: Aconite poisoning is a severe, life-threatening poisoning related to the use of traditional Chinese medicine (TCM). Despite current legislation, repeated poisoning cases are steadily encountered.Objective: The aim of the study was to summarize the clinical features and to elucidate the causative and contributory factors leading to aconite poisoning.Methods: This study was conducted within the Hospital Authority Toxicology Reference Laboratory, which is the sole tertiary referral clinical toxicology laboratory in Hong Kong. This retrospective study reviewed all confirmed aconite poisoning cases handled by a clinical toxicology laboratory between April 2004 and July 2009. The diagnosis in all cases was confirmed biochemically by detecting aconitum alkaloids in urine specimens. Additionally, herbal specimens were morphologically identified and herbal formulae were studied and transcribed. The cause of poisoning for each case was determined whenever possible.Results: Fifty-two cases were examined in this aconite poisoning case series. Neurological, cardiovascular and gastrointestinal toxicities were encountered in 49 (94.2%), 46 (88.5%) and 31 (59.6%) patients, respectively. The poisoning was severe in 6 (11.5%) patients, moderate in 17 (32.7%) patients and mild in 29 (55.8%) patients. Amongst 44 patients (84.6%) in whom the underlying reasons of poisoning could be determined, four major causes were found. These included overdose - prescription of a higher than recommended dosage of aconite herbs in 17 (32.7%) cases; 'hidden' poisoning (the aconite herb was not prescribed but dispensed inadvertently) in 17 (32.7%) cases; usage of inadequately processed herbs in 7 (13.5%) cases; and dispensary error in 2 (3.9%) cases. No case fatality was recorded.Conclusion: In the majority of cases in this series, the causes of poisoning can be traced to poor-quality herbs, poor quality of prescription practice, or dispensary errors. The quality issues of TCM practice should be critically addressed to minimize this poisoning threat. [ABSTRACT FROM AUTHOR]

The public wants an easy way to control obesity. Herbal anti-obesity products attract users because of their health claims, assumed safety, easy availability and extensive marketing. These products can be very heterogeneous in nature and have unpredictable levels of active ingredients, and unpredictable and potentially harmful effects. They may contain highly toxic herbs (e.g. Aristolochia species), potent herbs not recommended for use in weight control (e.g. Ephedra sinica) and herbal laxatives with potential hepatotoxic and nephrotoxic effects (e.g. anthraquinones). However, the presence of such herbs may not be disclosed on the product label. They may contain adulterants (e.g. drugs, drug analogues and thyroid extracts), including drugs that have been withdrawn from the market (e.g. fenfluramine). For all these reasons, herbal anti-obesity products can cause direct toxicity or adverse interactions with concurrent medications. Physicians and other healthcare professionals need to be aware of the problem. They should warn their patients about the heterogeneous nature of these agents and the potential risks associated with their use. They should report suspected adverse reactions to their national spontaneous reporting system. [ABSTRACT FROM AUTHOR]

Functional and efficient medical equipment is at the core of modern healthcare delivery, particularly in medical imaging. Growing healthcare costs and constrained budgets can delay equipment renewal. Aging equipment risks malfunction, potentially causing injury to patients and staff, and downtimes delaying patient care and impacting departmental revenue. Extensive equipment failure can lead to significant operational disruption which can compromise the delivery of timely and quality healthcare. Although extensive equipment failure is uncommon, 2 interventional radiology divisions at tertiary academic hospitals in Canada and the UK recently faced such a crisis. Their experiences of crisis and recovery inform this review of angiography equipment failure, and the principles learned. The concept of organizational resilience is introduced as a framework through which we review the crises. This concept can be split into successive and cooperative stages of anticipation, coping, and adaptation. Resilient organizations can identify potential threats, cope with unexpected crises, and recover swiftly to ensure future success. The author's experience of critical angiography unit failure, their response, and lessons learned are reviewed. We find these principles are broadly applicable to other medical imaging divisions and relevant to any system reliant on technology for healthcare delivery., 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.

Introduction: Lung cancer is one of the most prevalent malignancies worldwide. Substantial research has illuminated the intricate interplay between microorganisms and human health, revealing their role in disease regulation. Trichomonads is a flagellated protozoan in the human cavity and have been previously identified as a pathogen associated with pneumonia, contributing to tissue chronic inflammation and carcinogenesis., Methods: Nested polymerase chain reaction methods were employed to scrutinize the prevalence of trichomonads in the bronchovesicular fluid of patients diagnosed with lung cancer. Subsequently, the influence of Trichomonas tenax invasion on lung cancer cells was elucidated through proliferation assays, migration assays, and transcription analysis., Results: Bronchoalveolar fluid samples from lung cancer patients yielded positive nested PCR results for eight out of twenty-seven samples. Seven of these samples were identified as Trichomonas tenax, while one was identified as Tetratrichomonas spp. Our findings revealed a significant upregulation of pathways associated with carcinogenesis, including cellular proliferation, migration, and drug resistance, in response to T. tenax invasion., Conclusions: This study underscores the importance of recognizing the presence of trichomonads and the influence of T. tenax invasion on host responses to respiratory diseases. The identified pathways implicated in cancer development may pave the way for developing targeted treatment strategies for pulmonary diseases. These findings hold promise for informing and improving the precision of therapeutic interventions in the context of pulmonary ailments., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024. Published by Elsevier B.V.)

For much of terrestrial biodiversity, the evolutionary pathways of adaptation from marine ancestors are poorly understood and have usually been viewed as a binary trait. True crabs, the decapod crustacean infraorder Brachyura, comprise over 7600 species representing a striking diversity of morphology and ecology, including repeated adaptation to non-marine habitats. Here, we reconstruct the evolutionary history of Brachyura using new and published sequences of 10 genes for 344 tips spanning 88 of 109 brachyuran families. Using 36 newly vetted fossil calibrations, we infer that brachyurans most likely diverged in the Triassic, with family-level splits in the late Cretaceous and early Paleogene. By contrast, the root age is underestimated with automated sampling of 328 fossil occurrences explicitly incorporated into the tree prior, suggesting such models are a poor fit under heterogeneous fossil preservation. We apply recently defined trait-by-environment associations to classify a gradient of transitions from marine to terrestrial lifestyles. We estimate that crabs left the marine environment at least 7 and up to 17 times convergently, and returned to the sea from non-marine environments at least twice. Although the most highly terrestrial- and many freshwater-adapted crabs are concentrated in Thoracotremata, Bayesian threshold models of ancestral state reconstruction fail to identify shifts to higher terrestrial grades due to the degree of underlying change required. Lineages throughout our tree inhabit intertidal and marginal marine environments, corroborating the inference that the early stages of terrestrial adaptation have a lower threshold to evolve. Our framework and extensive new fossil and natural history datasets will enable future comparisons of non-marine adaptation at the morphological and molecular level. Crabs provide an important window into the early processes of adaptation to novel environments, and different degrees of evolutionary constraint that might help predict these pathways. [Brachyura; convergent evolution; crustaceans; divergence times; fossil calibration; molecular phylogeny; terrestrialization; threshold model.]., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Society of Systematic Biologists.)

This study assesses the quality of retinal images captured using a non-mydriatic fundus camera within a teleophthalmologic platform in Taiwan. The objective was to evaluate the effectiveness of non-mydriatic fundus cameras for remote retinal screening and identify factors impacting image quality. From June 2020 to August 2022, 629 patients from five rural infirmaries underwent ophthalmic examinations, with fundus images captured without pupil dilation. These images were reviewed by senior ophthalmologists and graded based on quality. The results indicated that approximately 70% of images were of satisfactory diagnostic quality. Risk factors for poor image quality included older age, the presence of cataracts, pseudophakia, and diabetes mellitus. This study demonstrates the feasibility of using non-mydriatic fundus cameras for teleophthalmology, highlighting the importance of identifying and addressing factors that affect image quality to enhance diagnostic accuracy in remote settings.

Acral melanoma (AM) is an aggressive melanoma variant that arises from palmar, plantar, and nail unit melanocytes. Compared to non-acral cutaneous melanoma (CM), AM is biologically distinct, has an equal incidence across genetic ancestries, typically presents in advanced stage disease, is less responsive to therapy, and has an overall worse prognosis. Independent analysis of published genomic and transcriptomic sequencing identified that receptor tyrosine kinase (RTK) ligands and adapter proteins are frequently amplified, translocated, and/or overexpressed in AM. To target these unique genetic changes, a zebrafish acral melanoma model was exposed to a panel of narrow and broad spectrum multi-RTK inhibitors, revealing that dual FGFR/VEGFR inhibitors decrease acral-analogous melanocyte proliferation and migration. The potent pan-FGFR/VEGFR inhibitor, Lenvatinib, uniformly induces tumor regression in AM patient-derived xenograft (PDX) tumors but only slows tumor growth in CM models. Unlike other multi-RTK inhibitors, Lenvatinib is not directly cytotoxic to dissociated AM PDX tumor cells and instead disrupts tumor architecture and vascular networks. Considering the great difficulty in establishing AM cell culture lines, these findings suggest that AM may be more sensitive to microenvironment perturbations than CM. In conclusion, dual FGFR/VEGFR inhibition may be a viable therapeutic strategy that targets the unique biology of AM., Competing Interests: CONFLICT OF INTEREST STATEMENTS: The authors declare no conflict of interest.

Trichomonas tenax , an oral commensal parasite commonly found in the human mouth, is associated with periodontitis and poor oral hygiene. However, it has also been identified in the bronchoalveolar lavage fluid (BALF) of individuals with lung diseases. Notably, significant quantities of T. tenax have been isolated following bronchoscopy in cases of empyema and acute respiratory distress syndrome (ARDS). Furthermore, research has demonstrated its ability to induce inflammation in pulmonary epithelial cells. To comprehend the potential role of T. tenax in pneumonia, it is crucial to elucidate the relationship between the parasite and the disease. We investigated the clinical factors associated with T. tenax infection in patients with pneumonia. Employing nested polymerase chain reactions, we amplified nucleic acids from BALF and analyzed the relationships between T. tenax and various clinical factors. Our data revealed a significant association between T. tenax and bacterial infections, high pneumonia severity index (PSI) scores, nasogastric tube feeding, and pulmonary complications. Logistic regression analyses also showed strong associations between T. tenax and these clinical factors in pneumonia patients. These findings suggest that T. tenax infection in pneumonia is accompanied by bacterial infection and severe clinical manifestations., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Wei-Chen Lin reports financial support was provided by National Science and Technology Council. Ching-Han Lai reports financial support was provided by 10.13039/501100004844National Cheng Kung University Hospital. Yu-Ting Lai reports financial support was provided by Ditmanson Medical Foundation 10.13039/501100012537Chiayi Christian Hospital Research Program. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

The Pencil Beam Scanning (PBS) technique in modern particle therapy offers a highly conformal dose distribution but poses challenges due to the interplay effect, an interaction between respiration-induced organ movement and PBS. This study evaluates the effectiveness of different volumetric rescanning strategies in mitigating this effect in liver cancer proton therapy. We used a Geant4-based Monte Carlo simulation toolkit, 'TOPAS,' and an image registration toolbox, 'Elastix,' to calculate 4D dose distributions from 5 patients' four-dimensional computed tomography (4DCT). We analyzed the homogeneity index (HI) value of the Clinical Tumor Volume (CTV) at different rescan numbers and treatment times. Our results indicate that dose homogeneity stabilizes at a low point after a week of treatment, implying that both rescanning and fractionation treatments help mitigate the interplay effect. Notably, an increase in the number of rescans doesn't significantly reduce the mean dose to normal tissue but effectively prevents high localized doses to tissue adjacent to the CTV. Rescanning techniques, based on statistical averaging, require no extra equipment or patient cooperation, making them widely accessible. However, the number of rescans, tumor location, diaphragm movement, and treatment fractionation significantly influence their effectiveness. Therefore, deciding the number of rescans should involve considering the number of beams, treatment fraction size, and total delivery time to avoid unnecessary treatment extension without significant clinical benefits. The results showed that 2-3 rescans are more clinically suitable for liver cancer patients undergoing proton therapy., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Japanese Radiation Research Society and Japanese Society for Radiation Oncology.)

Urban populations are exposed to a multitude of traffic-related air pollutants during daily commutes. This study assessed commuters' exposure to volatile organic compounds (VOCs) during bus, motorcycle, and bicycle commuting, and estimated the VOC inhalation dose. Benzene, toluene, ethylbenzene, and xylene (BTEX) were the main compounds detected, contributing 58 - 68% to ΣVOC (sum of the concentrations of all detected VOCs) in different travel modes. The mean ΣVOC exposure concentration was higher for motorcyclists than for cyclists and bus commuters. However, due to cyclists' higher minute ventilation rates and longer exposure time, they had the highest ΣVOC inhalation dose based on both travel time (7.09 ± 2.36 μg min -1 ) and distance (32.9 ± 10.8 μg km -1 ). Among the three travel modes, bus commuters had the lowest ΣVOC inhalation dose based on travel time (2.33 ± 1.18 μg min -1 ) and distance (8.91 ± 4.91 μg km -1 ), while motorcyclists had a moderate ΣVOC inhalation dose based on travel time (5.08 ± 1.46 μg min -1 ) and distance (13.4 ± 5.5 μg km -1 ). Health impact assessment of VOCs showed that cyclists faced the highest carcinogenic and non-carcinogenic risks, while bus commuters experienced the lowest health risk associated with VOC exposure. Our findings underscore the need to consider air quality in transportation infrastructure design and prioritize interventions to safeguard urban commuters' health, particularly cyclists, who are the most vulnerable to the adverse effects of traffic-related air pollutants., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objectives: Our objectives were to investigate the characteristics of people living with HIV who presented with new or recurrent symptoms in the context of re-emergence of cerebrospinal fluid HIV RNA escape after antiretroviral therapy (ART) modification (termed relapse of CSF HIV RNA escape)., Methods: People living with HIV-1 with known CSF HIV RNA escape were identified, with clinical and laboratory data obtained from records in a tertiary centre. CSF HIV RNA escape was defined as quantifiable CSF HIV RNA in the presence of unquantifiable plasma HIV-RNA or CSF HIV RNA greater than plasma HIV RNA in cases where plasma HIV-RNA was quantifiable. Relapse was defined as a re-emergence of CSF HIV RNA escape with new symptoms after ART therapy intensification post-initial CSF HIV RNA escape., Results: Among 40 people living with HIV who presented with neurosymptomatic CSF HIV RNA, eight (20%) presented with a relapse of CSF HIV RNA escape. Symptoms on relapse included confusion (n = 2), cognitive decline (n = 2), cerebellar dysfunction (n = 2) and worsening of pre-existing seizures (n = 1). Prior to their relapse, three people underwent drug therapy modification, with two people stopping raltegravir intensification, and one person switched from tenofovir alafenamide, emtricitabine and raltegravir for a new regimen., Conclusions: People with a relapse of CSF HIV RNA escape within this cohort presented with varied symptoms similar to their initial CSF HIV RNA escape. Clinicians should be vigilant of relapse of symptoms, particularly when simplifying ART regimens in people with CSF HIV RNA escape., (© 2023 British HIV Association.)

Five species in the penaeid shrimp genus Parapenaeopsis Alcock, 1901 are reported from Taiwan. Parapenaeopsis amicus V.C. Nguyn, 1971 and P. venusta De Man, 1907 are formally recorded in Taiwan for the first time. Taxonomic problems related to the species reported from Taiwan are discussed, and a key to the species of Parapenaeopsis in Taiwan is provided.

The tideland snails Pirenella nipponica and Pirenella asiatica are distributed north of the central Ryukyu Islands and in South Ryukyu, respectively, in Japan. To reveal their distribution and genetic characteristics in Taiwan, we sampled Pirenella snails along the western coast of Taiwan Island and analyzed the nucleotide sequences of their mitochondrial DNAs. Pirenella nipponica and P. asiatica inhabit the northern and southern parts of the western coast of Taiwan, respectively, and coexist only in the central part. Taiwanese and Japanese populations of P. asiatica showed significant genetic differentiation. The former showed higher genetic diversity and a larger effective population size than the latter. However, the Taiwanese population of P. nipponica was not genetically deviated from the local Japanese population on Kyushu Island. Both the Taiwan and Kyushu populations of P. nipponica showed significant genetic differences from local populations in other regions of Japan, namely, Honshu Island (the Japanese mainland) and Central Ryukyu. They also showed higher genetic diversity and a larger effective population size than the others. The Taiwanese populations of both species might be part of a large panmictic population with individuals from the Asian continent and Kyushu Island.

Purpose: We compare Prostate Health Index, Prostate Health Index density, and PSA density in predicting clinically significant prostate cancer in MRI-guided prostate biopsy., Materials and Methods: This is a multicenter evaluation of prospectively maintained prostate biopsy databases at 10 urology centers. Men with Prostate Health Index and MRI-guided targeted and systematic prostate biopsy performed and without prior prostate cancer diagnosis were included. The additional value of PSA density, Prostate Health Index, and Prostate Health Index density to MRI PI-RADS (Prostate Imaging Reporting & Data System) score was evaluated with multivariable analyses, area under the curve, and decision curve analyses. The proportion of unnecessary biopsies that can be avoided are estimated for clinically significant prostate cancer (International Society of Urological Pathology group ≥2 prostate cancer)., Results: A total of 1,215 men were analyzed. Prostate cancer and clinically significant prostate cancer were diagnosed in 51% (617/1,215) and 35% (422/1,215) of men, respectively. Clinically significant prostate cancer was diagnosed in 4.4% (3/68), 15% (72/470), 39% (176/446), and 74% (171/231) of highest PI-RADS score of 2, 3, 4, and 5 lesions, respectively. In multivariable analyses, independent predictors for clinically significant prostate cancer detection included Prostate Health Index (OR 1.04), prostate volume (OR 0.97), and PI-RADS score 4 (OR 2.81) and 5 (OR 8.34). Area under the curve for clinically significant prostate cancer of PI-RADS + Prostate Health Index density (0.85) was superior to PI-RADS + PSA density (0.81), Prostate Health Index density (0.81), Prostate Health Index (0.78), PI-RADS (0.76), PSA density (0.72), and PSA (0.60) in the whole cohort, and the superiority of Prostate Health Index density was also observed in PI-RADS 3 lesions. Decision curve analysis showed Prostate Health Index density achieving the best net clinical benefit in PI-RADS 3 or 4 cases. Among PI-RADS 3 lesions, using cutoffs of PSA density 0.15, Prostate Health Index 38.0, and Prostate Health Index density 0.83 could reduce 58%, 67%, and 72% of unnecessary biopsies, respectively., Conclusions: Prostate Health Index density outperformed Prostate Health Index or PSA density in clinically significant prostate cancer detection in men with multiparametric MRI performed, and further reduced unnecessary biopsies in PI-RADS 3 lesions.

Two species of the squat lobster family Munidopsidae, Munidopsisalbatrossae Pequegnat & Pequegnat, 1973 and M.pycnopoda Baba, 2005, are reported from Taiwan for the first time based on specimens collected from lower bathyal depths. The Taiwanese material of M.pycnopoda also represents the first record of the species from the Pacific Ocean and greatly extends this species' geographical range from the western Indian Ocean to western Pacific. The giant Munidopsis specimen from Taiwan is identified as M.albatrossae mainly by DNA barcoding even though M.albatrossae and M.aries (A. Milne-Edwards, 1880) are both morphologically and genetically extremely similar., Competing Interests: No conflict of interest was declared., (Masayuki Osawa, Tin-Yam Chan, Chien-Hui Yang.)

Alveolar macrophages (AMs) are the drivers of pulmonary cytokine storm in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study aimed to investigate clinical-regulatory factors for the entrance protein of SARS-CoV-2, angiotensin-converting enzyme 2 (ACE2) in AMs. Human AMs were collected from 56 patients using bronchoalveolar lavage. ACE2 expression in AMs was positively correlated with smoking pack-year (Spearman's r = 0.347, P = 0.038). In multivariate analysis, current smoking was associated with increased ACE2 in AMs (β-coefficient: 0.791, 95% CI 0.019-1.562, P = 0.045). In vitro study, ex-vivo human AMs with higher ACE2 were more susceptible to SARS-CoV-2 pseudovirus (CoV-2 PsV). Treating human AMs using cigarette smoking extract (CSE) increases the ACE2 and susceptibility to CoV-2 PsV. CSE did not significantly increase the ACE2 in AMs of reactive oxygen species (ROS) deficient Cybb -/- mice; however, exogenous ROS increased the ACE2 in Cybb -/- AMs. N-acetylcysteine (NAC) decreases ACE2 by suppressing intracellular ROS in human AMs. In conclusion, cigarette smoking increases the susceptibility to SARS-CoV-2 by increasing ROS-induced ACE2 expression of AMs. Further investigation into the preventive effect of NAC on the pulmonary complications of COVID-19 is required., (© 2023. The Author(s).)

Introduction: Obesity and diabetes are public health concerns worldwide, but few studies have examined the habitual intake of minerals on body composition in people with prediabetes., Methods: In this prospective cross-sectional study, 155 Chinese subjects with IGT [median age: 59 (53-62) years, 58% female] had an assessment of body composition including body fat percentage, oral glucose tolerance tests (OGTT), Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and 3-day food records from nutritional programme analysis., Results: Dietary intake of minerals was negatively correlated with body fat. People with obesity had the lowest daily consumption of iron median (IQR) 10.3 (6.9-13.3) mg, magnesium 224 (181-282) mg, and potassium 1973 (1563-2,357) mg when compared to overweight [10.5 (8.0-14.5) mg, 273 (221-335) mg, and 2,204 (1720-2,650) mg] and normal weight individuals [13.2 (10.0-18.6) mg, 313 (243-368) mg, and 2,295 (1833-3,037) mg] ( p  = 0.008, <0.0001, and 0.013 respectively). Amongst targeted minerals, higher dietary magnesium and potassium intake remained significantly associated with lower body fat after the adjustment of age, gender, macronutrients, fibre, and physical activity., Conclusion: Dietary magnesium and potassium intake may be associated with lower body fat in people with impaired glucose tolerance. Inadequate dietary mineral intake may play contribute to obesity and metabolic disorders independent of macronutrients and fibre consumption., 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 Chu, Chan, Chu, Ling, He, Leung, Ma, Chan and Chow.)

Although a recent comprehensive molecular phylogenetic study on Penaeus Fabricius, 1798 reinstated a single genus for these economically important shrimps, several clades in the molecular phylogenetic tree do not have formal names. Subgeneric names are given herein to five of these clades if Penaeus is to be split. A key to the subgenera in Penaeus is also provided., (Tin-Yam Chan.)

Calculation of 31 P NMR chemical shifts for a series of tri- and tetracoordinate phosphorus compounds using several basis sets and density functional theory (DFT) functionals gave a modest fit to experimental chemical shifts, but an excellent linear fit when plotted against the experimental values. The resultant scaling methods were then applied to a variety of "large" compounds previously selected by Latypov et al. and a set of stereoisomeric and unusual compounds selected here. No one method was best for all structural types. For compounds that contain P-P bonds and P-C multiple bonds, the Latypov et al. method using the PBE0 functional was best (mean absolute deviation/root mean square deviation (MAD/RMSD) = 6.9/8.5 ppm and 6.6/8.2 ppm, respectively), but for the full set of compounds gave higher deviations (MAD/RMSD = 8.2/12.3 ppm), and failed by over 60 ppm for a three-membered phosphorus heterocycle. Use of the M06-2X functional for both the structural optimization and NMR chemical shift calculation was best overall for the compounds without P-C multiple bonds (MAD/RMSD = 5.4/7.1 ppm), but failed by 30-49 ppm for compounds having any P-C multiple-bond character. Failures of these magnitudes have not been reported previously for these widely used functionals. These failures were then used to screen a variety of recommended functionals, leading to better overall methods for calculation of these chemical shifts: optimization with the M06-2X functional and NMR calculation with the PBE0 or ωB97x-D functionals gave values for MAD/RMSD = 6.9/8.5 ppm and 6.8/9.1 ppm, respectively, over an experimental chemical shift range of -181 to 356 ppm. Due to the unexplained failures observed, we recommend use of more than one method when looking at novel structures., (Copyright © 2023, Hersh and Chan.)

Aim: To assess the improvements during patient follow-up after implementing a proactive plan for retrieval of inferior vena cava (IVC) filters., Materials and Methods: A retrospective study was undertaken including all patients who had a temporary IVC filter inserted over a 10-year period. Patient demographics, insertion dates, retrieval dates, retrieval rates, and complications were recorded. Patients were categorised into three groups as follows: group A, no intervention where retrieval was not suggested; group B, passive intervention where retrieval was suggested but no appointment made; and group C, proactive intervention where a retrieval date was booked by the radiologist., Results: Five hundred and nine patients had a temporary IVC filter inserted at Royal Liverpool University Hospital over the study period. One per cent of patients in group C were lost to follow-up compared to 41% and 29% in groups A and B respectively (p<0.001). The number of patients who had an IVC retrieval attempt also increased to 80% in group C compared to 53% and 64% in groups A and B (p<0.001)., Conclusion: Incorporation of a proactive retrieval booking system has significantly reduced the number of patients lost to follow-up to 1%, leading to an increased number of IVC filter retrieval attempts., (Copyright © 2022 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)