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Gallbladder cancer (GBC) starts in the epithelial tissue (lining of the bile duct and gallbladder). It is a type of aggressive cancer called adenocarcinoma that can spread to other tissues. Among all cases of biliary tract cancer, 50% is from GBC. It is a deadly cancer with a survival rate of 17.6% between 2007 and 2013. GBC is rarely found in the Western world, but it is commonly found in South Asia. In Southeast Asian countries, GBC plays a significant role in cancer-related morbidity and mortality. GBC incidence exhibits marked regional variability, a rare condition in the western population but having a higher frequency in India, especially the Indo-Gangetic belt and some northeast districts excluding Nagaland. This might be attributed to the differences in environmental factors and genetic predisposition modulating carcinogenesis. In GBC, only 10% of cases are identified in the early stages. The low rate of early detection is due to the lack of screening techniques and the aggressive characteristics of the tumor. Various risk factors are associated with GBC, for example, chronic cholecystitis with or without gallstones, obesity, exposure to heavy metals such as lead and arsenic, bacterial infection, congenital biliary cysts, and abnormal pancreaticobiliary duct junction. The risk factors can cause chronic gallbladder mucosa irritation, leading to dysplasia and neoplasia. GBC can form metaplasia to dysplasia in a time span of 5–15 years, then to carcinoma in situ, and finally to invasive cancer. Dysbiosis is responsible for various diseases, including cancer. Multiple triggers can cause dysbiosis, for example, environmental changes, inflammation, infection, medications, dietary changes, or genetic predisposition. Various researches show that Helicobacter pylori, human papillomavirus, Hepatitis B virus, and Hepatitis C virus microbial species can cause cancer. They are the major species responsible for 90% of infection-associated cancers. Various studies demonstrate that the strains of Salmonella and Helicobacter colonize are linked to developing GBC. While the mechanisms linking gut microbiota to GBC are not fully understood, several studies have suggested a potential association. According to a study, certain gut microbiomes, such as Fusobacterium nucleatum, found glut in GBC tissues, compared to adjacent normal tissues. By evaluating gut microbiome dysbiosis, we can see the potential link between gut microbiome dysbiosis and GBC; it may provide valuable insights into the development and progression of GBC. It could lead to the identification of new diagnostic markers and the development of novel therapeutic strategies. In GBC, the evaluation of gut microbiome dysbiosis (involving evaluating the composition, diversity, and functional capacity of the gut microbiome in patients) has emerged as a promising method for understanding the molecular mechanisms and identifying biomarkers for early prevention and detection of GBC and also investigating the possibility of any link between the gut microbiome and host immune response. In conclusion, evaluating gut microbiome dysbiosis in GBC is a promising direction for identifying potential early detection and prevention biomarkers. Additional investigation is therefore needed to determine the role of gut microbiome dysbiosis in the development and progression of GBC and to identify reliable biomarkers for clinical use.

Background: An extremely rare kind of hernia is the traumatic abdominal hernia. It is frequently misdiagnosed, and diagnosing it calls for a high degree of suspicion. Case history: Following a collision with a scooter and a blow to his abdomen from one of the handles, a 40-year-old man was brought to the emergency room complaining of abdominal pain. A left lower abdominal wall hernia was suggested by USG-eFAST. Hernioplasty with meshplasty was performed on the patient. Results: There were no complications following surgery. Conclusions: When a patient is diagnosed with a traumatic abdominal wall hernia, they should have a thorough examination to rule out early signs of organ damage and then have their abdomens radiologically examined to check for intra-abdominal injuries. The diagnosis and treatment of these cases still depend heavily on clinical examination and judgment. Given the possibility of the bowel loop becoming incarcerated, the definitive course of treatment, in this case, is surgical exploration combined with the primary repair of the defect.

Introduction: Ladd’s procedure, originally described in 1936 for the treatment of malrotation, does not traditionally include appendectomy as a standard step. We conducted a multinational survey to investigate the current consensus on the role of appendectomy in Ladd’s procedure. Methodology: An anonymous online survey was distributed to pediatric surgeons worldwide. The survey collected demographic data and explored surgical preferences related to the management of malrotation. Open-ended questions were used to assess the opinions regarding the necessity of appendectomy, decision-making factors, and complications associated with appendectomy during Ladd’s procedure. Results: A total of 343 responses were received from 46 countries. Of the respondents, 319 (93%) were consultants and 24 (7%) were residents/trainees. When asked about the choice between open and laparoscopic Ladd’s procedure, 292 (85%) preferred open surgery. Overall, 184 (53%) respondents favored appendectomy in both open and laparoscopic Ladd’s procedure. Furthermore, 172 (50%) surgeons advocated for appendectomy in all malrotation cases, citing concerns about potential future appendicitis. While differences existed between all comparisons, none of them reached statistical significance. The factors influencing the decision to preserve the appendix included the risk of postoperative complications and the potential future use of the appendix as a surgical conduit. The surgical complications following appendectomy included surgical site infections in 14 (33%) patients, adhesive obstruction in 13 (31%) patients, intrabdominal abscesses in 10 (24%) patients, and fecal fistulas in 5 (12%) patients. Conclusion: The majority of surgeons aim to perform appendectomy in all malrotation cases, considering the potential risks and benefits of this approach. These findings offer valuable insights for clinical practice and may inform future guidelines and decision-making algorithms.

Achieving an accurate estimation of the flow resistance in open channel flows is crucial for resolving several critical engineering difficulties. In instances when there is excessive flow on both banks of a river, it results in the breach of the primary channel, leading to the discharge of water into the adjacent floodplain. The alteration of floodplain geometry occurs as a consequence of agricultural and developmental practises, leading to the emergence of compound channels that exhibit converging, diverging, or skewed characteristics throughout the course of the flow. The efficacy of conventional equations in accurately forecasting flow resistance is limited due to their heavy reliance on empirical approaches. As a result of this phenomenon, there persists a significant need for methodologies that possess both novelty and precision. The objective of this work is to use the support vector machine (SVM) technique for the estimation of the Manning's roughness coefficient in a compound channel with converging floodplains. Statistical indicators are used to validate the constructed models in the experimental investigation, enabling the assessment of their performance and efficacy. The findings indicate a significant correlation between the Manning's roughness coefficient predicted by SVM and both experimental data and prior research outcomes. HIGHLIGHTS Flow resistance is crucial across various engineering contexts, such as planning irrigation systems, managing drainage networks, and constructing flood control structures.; This study delved into assessing flow resistance in non-prismatic compound channels by employing support vector machines.; The results indicate a strong alignment between the predicted Manning's roughness coefficient and the actual observed values.;

In the modern world, dams and the artificial reservoirs behind them serve the increasing demand for water across diverse needs such as agriculture, energy production, and drinking water. As dams continue to proliferate, monitoring water availability influenced by reservoir operations is now of paramount importance. The Reservoir Assessment Tool (RAT) is a data-driven software platform that integrates satellite remote sensing with hydrological models, enabling the estimation of key reservoir parameters such as inflow, outflow, surface area, evaporation, and storage changes. The earliest version of RAT (version 1.0) was set up for 1598 reservoirs around the world with limitations in functional robustness, updating frequency, and scalability. Some of these limitations on updating frequency and functional robustness were addressed in version 2.0 that was later made operational for the intergovernmental agency of the Mekong River Commission. Recognizing the need for scalability to mobilize the global water management community to benefit from satellite remote sensing, we hereby introduce RAT version 3.0. This version is optimized for accelerating open collaboration among users for continuous improvement and customization of RAT to enable reservoir management breakthroughs. RAT 3.0 represents a wholesale overhaul from the previous versions to empower the global community of users and developers in the spirit of the open-source movement. RAT 3.0 allows reservoir monitoring advancements and new functional developments that can be freely exchanged and seamlessly integrated for continuous evolution of the software. A centralized web application has also been established to facilitate the storage and dissemination of global reservoir monitoring information along with comprehensive training resources. RAT 3.0 aspires to bridge the traditional practices of water management community with the capabilities of satellite remote sensing. The global impact of the software can be expected to increase as uptake spreads, enabling a more sustainable and equitable utilization of our planet's water resources.

The scouring process near spur dikes poses a threat to riverbank stability, making it crucial for river engineering to accurately calculate the maximum scour depth. However, determining the maximum scour depth has been challenging due to the intricacy of scour phenomena surrounding these structures. This research introduces a reliable ensemble data-driven model by hybridizing random tree (RT) using additive regression (AR), bagging (B), and random subspace (RSS) for predicting scour depths around spur dikes. A database of 154 experimental observations was collected from literature, with 103 and 51 observations used for training and testing subsets, respectively. A dimensionless analysis was performed on the collected dataset, selecting four variables as input variables (v/vs, y/l, l/d50, and Fd50) and ds/l as response variables. The performance comparison demonstrates that B_AR_RT has a better coefficient of determination (R2) of 0.9693, root mean square error (RMSE) of 0.1305, and Nash–Sutcliffe efficiency (NSE) of 0.9692. Finally, a comparison of the best hybrid model has been done with previous studies, and sensitivity analysis is performed to determine the most influential parameter for predicting the scour depth around spur dikes. HIGHLIGHTS Development and inter-comparison of the multi-order novel hybrid ensemble data-driven models using additive regression, bagging, and random subspace.; The B_AR_RT, a novel hybrid ensemble model, has emerged as the most proficient model in predicting scour depth.; The sensitivity analysis is performed, and the dimensionless variable, l/d50, is the most influential parameter in predicting scour depth around spur dikes.;

The coronavirus disease 2019 (COVID-19) pandemic cost 7–8 million deaths worldwide, creating an unprecedented health and economic crisis. Affecting 700 million people globally, the magnitude of this pandemic is far from anything that humanity has encountered in recent times. A detailed investigation revealed that more than the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, the hyperactive immune system mediated injury as the real cause of mortality. Cytokine storm following viral infection leads to the surge of proinflammatory cytokines resulting in acute respiratory distress syndrome (ARDS) and lung injury. Anti-inflammatory intervention with anti-interleukin-6 (anti-IL-6) receptor monoclonal antibodies (mAbs; e.g., sarilumab and tocilizumab) and anti-IL-6 mAbs (i.e., siltuximab) and/or steroid-based approach leads to substantial protection and prevent death thereby implying the role of inflammation in COVID-19. In this review, the authors have summarized the dysregulated immune system in COVID-19 infection, investigating in detail the virus-host immune cross talks and presenting the possibilities of therapeutic intervention.

Summary: Background: We aimed to study the clinical characteristics, myocardial injury, and longitudinal outcomes of COVID-19 vaccine-associated myocarditis (C-VAM). Methods: In this longitudinal retrospective observational cohort multicenter study across 38 hospitals in the United States, 333 patients with C-VAM were compared with 100 patients with multisystem inflammatory syndrome in children (MIS-C). We included patients ≤30 years of age with a clinical diagnosis of acute myocarditis after COVID-19 vaccination based on clinical presentation, abnormal biomarkers and/or cardiovascular imaging findings. Demographics, past medical history, hospital course, biochemistry results, cardiovascular imaging, and follow-up information from April 2021 to November 2022 were collected. The primary outcome was presence of myocardial injury as evidenced by late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging. Findings: Patients with C-VAM were predominantly white (67%) adolescent males (91%, 15.7 ± 2.8 years). Their initial clinical course was more likely to be mild (80% vs. 23%, p 15 years, OR 2.74 [95% CI: 1.28, 5.83, p = 0.009]) and when C-VAM occurred after the first or second dose as compared to the third dose of mRNA vaccine. Mid-term clinical outcomes of C-VAM at a median follow-up of 178 days (IQR 114–285 days) were reassuring. No cardiac deaths or heart transplantations were reported until the time of submission of this report. LGE persisted in 60% of the patients at follow up. Interpretation: Myocardial injury at initial presentation and its persistence at follow up, despite a mild initial course and favorable mid-term clinical outcome, warrants continued clinical surveillance and long-term studies in affected patients with C-VAM. Funding: The U.S. Food and Drug Administration.

PurposeTo describe the technique and document utility of adjunctive cone-beam CT (CBCT) in patients undergoing bronchial artery embolization (BAE) or chemoinfusion (BAC).Materials and methodsBetween August 2010 and February 2021, 26 patients (62 bronchial arteries) were evaluated with CBCT in addition to the usual digital subtraction angiography (DSA) during BAE or BAC. 19 patients (43 arteries) underwent BAE for hemoptysis; 7 patients (19 arteries) had BAC for palliation of lung malignancy. Retrospective review of procedural reports and the archived DSA and CBCT images was assessed for (1) whether CBCT findings added unique diagnostic information prior to treatment of target arteries compared to DSA alone; and (2) whether these unique CBCT findings led to modification of embolization or chemoinfusion technique.ResultsIn 61 of 62 (98%) interrogated bronchial arteries, CBCT provided additional unique diagnostic information over planar DSA, primarily cross-sectional assessment of the spinal canal for spinal arteries. In 46/62 (74%) of the bronchial arteries the unique information did not lead to a change in therapeutic technique. In 15 bronchial arteries (24%), the added information from CBCT led to change in embolization and/or chemoinfusion technique. Embolization of one small unrecognized spinal artery branch (1.6%), which was missed intra-procedurally but retrospectively seen on CBCT led to transient spinal cord ischemia.ConclusionsThese results suggest that adjunctive use of CBCT technique may improve diagnostic confidence from information provided by DSA in nearly all cases of BAE and BAC leading to improved therapeutic targeting or change in technique of embolization or chemoinfusion.

Converting biowaste into a functional product is put to the test by the growing amount of biowaste in the world and the environmental problems it causes. In this research study, we synthesized, characterized, and evaluated bluish-green luminescent carbon nanodots (CNDs) from cow dung and expired tomato sauces via a hydrothermal synthesis method at 160 °C for 8 h. The carbon nanodots were fabricated without additional passivating agents and exhibited good physicochemical and optical properties. The intrinsic properties of carbon nanodots were characterized using various spectral techniques. First, we evaluated the cytotoxic potential of carbon nanodots against A-375 human melanoma cell lines. This study revealed that carbon nanodots exhibited potent cytotoxicity and significantly inhibited the proliferation of A-375 cells in a dose-dependent manner. Next, we demonstrated these carbon nanodot's free radical scavenging potential by employing 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay. The bluish-green fluorescent carbon nanodots fabricated using a green synthesis approach have broad potential for biological applications.

Background: The majority of breast illnesses manifest as a palpable mass. The vast majority of breast lesions are not malignant, and the vast majority of benign lesions do not progress to cancer; however, the accuracy of diagnosis can be improved by a combination of preoperative tests such as physical examination, mammography, fine-needle aspiration cytology (FNAC), and Trucut needle biopsy (TCNB) or core needle biopsy (CNB). FNAC has gained in popularity and is now the primary treatment performed after a history and clinical examination to diagnose solid and cystic breast masses. This study was designed to assess the accuracy of FNAC in comparison to Triple Test and TCNB for the diagnosis of breast masses. Methodology: From January 2023 through May 2023, this study was conducted in the Tezpur Medical College and Hospital. The research included all female patients over the age of 20 with clinically palpable lumps. Palpable breast lumps need a complete clinical breast examination, imaging, and tissue sample for a clear diagnosis to rule out cancer.The Ultrasonography/Mammography, FNAC and tru-cut biopsy procedures were performed concurrently in the same region, and the results were compared to final histopathology as the gold standard. Result: The majority of the patients in the study were in age group of > 60 years. In our study Left breast was involved in 41 (58.5%) patients and right breast in 29 (41.4%) patients. The most frequent site involved was upper outer quadrant in 38 (54.2%). The overall sensitivity of FNAC in our study was 93.75%, tru-cut biopsy is 100% and that of triple test is 100% and specificity for malignancy was 91.6%, 93.6 and 95.6% for FNAC, tru-cut biopsy and triple test respectively. Conclusion: All three techniques have advantages and disadvantages. Core Needle Biopsy cannot be used in place of FNAC, and it is not required to identify all breast lesions. It can be utilised as an adjuvant in circumstances when cytology is definitive and biomarker tests are required. triple test and trucut were more accurate than FNAC in our testing.Trucut biopsy was able to provide histological diagnosis, and the findings were 100% consistent with the final histopathology report.

Public engagement is recognised as having an increasingly important role in the changing landscape of higher education in the United Kingdom (UK), and is promoted as a 'pathway to impact' by many higher education funding bodies. However, there is limited evidence to support the outreach and impact gained by higher education institutes that undertake international public engagement activities. Similarly, little is known about higher education staff and student's experiences of participating in such public engagement activities. This study focusses on a Global Festival of Learning (GFoL) in delivering public engagement on an international stage through an integrated approach involving the fusion of education, research, and professional practice, and the perceived impact on staff and students. This paper proposes an adaptive model for public engagement founded on five strategic public engagement areas that can be transferred to other higher education institutes with an interest in developing their international outreach and impact.

Abstract Background Stroke has become a leading cause of death and disability worldwide, and despite the introduction of new screening programs, therapies, and monitoring technologies, there is still a need to develop more useful biochemical tests to monitor treatment response and inform clinical decision-making. Cell-free DNA released from damaged neurons in stroke patients may be useful in assessing stroke prognosis. The purpose of this study was to evaluate the role of cell-free DNA and a highly sensitive blood biomarker in acute ischemic stroke. 188 patients with acute ischemic stroke were recruited for the study. The level of cell-free DNA in plasma was estimated using a real-time PCR assay for the β-globin gene (Qiagen-Rotor-Gene Q MDX, Germany). Clinical assessment was performed with the National Institutes of Health Stroke Scale (NIHSS) at the time of admission. After a period of three months from the onset of stroke, (mRS) scores were estimated using the modified Rankin scale. Results Elevated levels of cell-free DNA were found in patients with higher NIHSS admission scores and mRS 3-month scores (p

Under the current practice in organizing surgical services, proportionate representation of disciplines is provided in the curricular planning and in corresponding clinical functions. This is based on the level of competence expected by the end of training period. The disciplines as a “whole” are placed in general surgery or super specialty. The system of vertical arrangement has some serious concerns. Paradoxically, patients with diseases of simple and routine nature of discipline categorized as super specialty are neglected. Super specialist is unable to attend on account of preoccupation with serious challenging problems. The general surgeon hesitates because of privileging issues, fear of allegations of negligence and litigation. The system of vertical division is based on premise that some disciplines deal with complex procedures and others with only simple and routine nature. This premise is incorrect. Each discipline is a mix of simple and complex cases requiring specialized treatment. Alternate modified organization of surgical service is proposed. Activities of all disciplines are scrutinized according to the level of expected competence by the end of training. Categorization is shifted from the “discipline' to “activities.” Criteria applied for classification of activities are as follows: on completion, the trainee is capable to assume full responsibility-category 1; has gained sufficient experience-category 2; and is conversant with broad understanding of management-category 3. Activities of category 1 from all disciplines are assigned to general surgery and those of category 3 from all disciplines are assigned to respective super specialty. Those in the middle, comprising difficult cases but not requiring specialized training or heavy inputs in equipment, are in category 2. They are assigned to general surgery as additional/optional items, or super specialty, guided by local factors. The scope and practice of general surgery are broadened with a shift from “residual” to “comprehensive” discipline. Advantages, concerns, collateral issues of horizontal distribution of activities, its positive impact on research and education are discussed. It is concluded that the proposed organization of surgical services is a rational, logical, and practical strategy for good-quality surgical care in the society. The super specialists need to be convinced that “taking load off” is good for the specialty.

Massive open online courses (MOOCs) are widely available and have become a common option for learners. However, their full potential cannot be realised if they are not accessible to all learners, including those with disabilities. It is, therefore, important to understand the different stakeholders and their requirements and perspectives in designing accessible MOOCs. This research investigated the perspectives of MOOC providers on MOOC learners who have accessibility needs and the processes used to manage accessibility and MOOCs in their individual organisations. In this paper, we report the results of a study using thematic analysis, which involved 26 semi-structured interviews with MOOC providers and focused on MOOC accessibility. The results show that, while MOOC providers are aware of learners with accessibility needs who are participating in MOOCs, they prioritise legislation over learners' accessibility preferences. MOOC providers consider the technology of the platform itself creates barriers and are aware of the limitations for learners in finding help, reporting accessibility barriers and obtaining feedback, when participating in MOOCs.

Worsening heart failure (WHF) is a distinct under-diagnosed and under-treated condition, independent of location of care. Heart failure (HF) progression is punctuated by repeated WHF events, each resulting in reduced cardiac function. One-third of the patients with HF with reduced ejection fraction experience a decompensation event. These decompensation events often result in the emergency department visits and HF hospitalization. Despite its inclusion in recent guidelines, there is no precise definition of WHF or its various forms. It is worth noting that WHF signals a need for treatment optimization as per guideline-directed medical therapy and the addition of novel drugs like a stimulator of soluble guanylate cyclase that benefit this high-risk patient population. This practical document is based on the expert opinion of cardiologists, cardiothoracic surgeons, and physicians that discussed the definition, assessment, pharmacological management, and monitoring of WHF patients in a hospitalized setting. In addition, there is also a need for an expert opinion for the management of WHF in an outpatient setting.

A 77-year-old man with history of sacral chordoma and pulmonary embolism presented to the emergency room with a 1-day history of diffuse left flank and lower extremity swelling. The patient was found to have thrombus in the left common and external iliac veins. The patient was brought to Interventional Radiology for mechanical thrombectomy using the Inari ClotTriever and a sample of extracted thrombus was sent to pathology. Analysis on the sample was positive for sacral chordoma, consistent with tumor thrombus. The patient returned after 6 weeks with similar symptoms and repeat mechanical thrombectomy was performed with the Inari ClotTriever and stent placement through the left common and external iliac vein with an Ovation iX stent graft. The patient remained asymptomatic following the second procedure at repeat follow-up at 6 weeks.