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Jason Reinglas,1 Kirstin Perdrizet,1 Stephen E Ryan,2 Rakesh V Patel1 1Department of Medicine, 2Department of Diagnostic Imaging, University of Ottawa, Ottawa Hospital, Ottawa, ON, Canada Abstract: Splenosis, the autotransplantation of splenic tissue following splenic trauma, is uncommonly clinically significant. Splenosis is typically diagnosed incidentally on imaging or at laparotomy and has been mistakenly attributed to various malignancies and pathological conditions. On the rare occasion when splenosis plays a causative role in a pathological condition, a diagnostic challenge may ensue that can lead to a delay in both diagnosis and treatment. The following case report describes a patient presenting with a massive upper gastrointestinal bleed resulting from arterial enlargement within the gastric fundus secondary to perigastric splenosis. The cause of the bleeding was initially elusive and this case highlights the importance of a thorough clinical history when faced with a diagnostic challenge. Treatment options, including the successful use of transarterial embolization in this case, are also presented. Keywords: therapeutic, endoscopy, UGIB, intervention

Abstract In the United States, 2.0 million new cancer cases and around 600,000 cancer deaths are estimated to occur in 2024. Early detection gives cancer patients the best chance for treatment success. Currently, cancer screening in the general population is recommended for a limited set of cancers; as a result, most cancer types are not regularly screened. Thus, in recent years, we have seen a wave of novel, non‐invasive, single‐ and multi‐cancer detection tests (SCD and MCD), promising detection of cancer signals prior to the onset of symptoms and/or clinical diagnosis. To accelerate the development, access, and adoption of these tests, the Blood Profiling Atlas in Cancer (BLOODPAC) Consortium, a collaborative infrastructure for developing standards and best practices, established the Early Detection & Screening (ED&S) Working Group. The early detection space is in need of consensus around definitions for SCD and MCD tests that harmonize terminology across diverse stakeholders, thereby reducing communication barriers and ultimately advancing the discipline. To this end, the ED&S Working Group compiled a lexicon of terms, chosen based on perceived importance, frequency of use, lack of clarity, and unique challenges in the context of SCD and MCD tests. This lexicon was submitted to the FDA for their feedback, which was incorporated. In this work, we present the first installment of the lexicon, consisting of 14 primary terms, that will be part of an online dictionary and provide a foundation for future projects of BLOODPAC's ED&S Working Group.

Abstract 2D magnetic materials offer the opportunity to study and manipulate emergent collective excitations. Among these, spin–phonon coupling is one of the most important interactions correlating charge, spin and lattice vibrations. Understanding and controlling this coupling is important for spintronics applications, control of magnons and phonon by THz radiation, and for strain‐driven magnetoelastic applications. Here, a resonant mode‐selective spin–phonon coupling in several magnetic 2D metal thiophosphates (NiPS3, FePS3, CoPS3 and MnPS3) through multi‐excitation and temperature‐dependent Raman scattering measurements is uncovered. The phonon mode, which is a Raman‐active out‐of‐plane vibrational mode (∼250 cm−1 or 7.5 THz), exhibits an asymmetric Fano lineshape where its asymmetry is proportional to the spin–phonon coupling. The measurements reveal the coupling to be the highest in NiPS3, followed by FePS3 and CoPS3, and least in MnPS3. These differences are attributed to the metal–sulfur interatomic distances, which are the lowest in NiPS3, followed by CoPS3, FePS3 and MnPS3. Finally, the spin–phonon coupling is also observed in exfoliated materials, with a slight reduction between 20 and 30% in the thinnest flakes compared to the bulk crystals.

A 54-year-old woman with a diagnosis of Erdheim-Chester disease under therapy with dabrafenib presents with clinical signs of heart failure. After discontinuing the offending medication and initiating guideline-directed medical therapy for heart failure with reduced ejection fraction, the clinical picture improved.

Objective: This study aims to evaluate the effect of Clostridium perfringens sialidase treatment on monolayer cell behavior using computational screening and an in vitro approach to demonstrate interaction between enzyme-based drugs and ligands in host cells. Materials and Methods: The in silico study was carried out by molecular docking analysis used to predict the interactions between atoms that occur, followed by genetic characterization of sialidase from a wild isolate. Sialidase, which has undergone further production and purification processes exposed to chicken embryonic fibroblast cell culture, and observations-based structural morphology of cells compared between treated cells and normal cells without treatment. Results: Based on an in silico study, C. perfringens sialidase has an excellent binding affinity with Neu5Acα (2.3) Gal ligand receptor with Gibbs energy value (ΔG)—7.35 kcal/mol and Ki value of 4.11 μM. Wild C. perfringens isolates in this study have 99.1%–100% similarity to the plc gene, NanH, and NanI genes, while NanJ shows 93.18% similarity compared to the reference isolate from GenBank. Sialidase at 750 and 150 mU may impact the viability, cell count, and cell behavior structure of fibroblast cells by significantly increasing the empty area and perimeter of chicken embryo fibroblast (CEF) cells, while at 30 mU sialidase shows no significant difference compared with mock control. Conclusion: Sialidase-derived C. perfringens has the capacity to compete with viral molecules for attachment to host sialic acid based on in silico analysis. However, sialidase treatment has an impact on monolayer cell fibroblasts given exposure to high doses. [J Adv Vet Anim Res 2023; 10(4.000): 667-676]

Astaxanthin is a lucrative, biologically-derived xanthophyll compound used in a variety of industrial applications, ranging from human health and nutrition to cosmetics and animal feed. The stability of astaxanthin is limited and proper storage must be considered to ensure the full benefit of its oxidative capabilities. Pure extracted astaxanthin was subjected to oxidation factors of illumination and temperature for 11 weeks. NMR experiments were conducted to evaluate any oxidation or structural change over this period of time. To determine the rate of decomposition and oxidation of intracellular astaxanthin, ‘whole cell’ algal biomass from Haematococcus pluvialis rich in astaxanthin was stored under different conditions and tested in the presence of light and heat. The results showed that the extracted astaxanthin compound itself was stable while intracellular astaxanthin showed low stability in similar conditions, suggesting other biotic or chemical factors may degrade the carotenoid if not stored properly. Lower temperatures and the absence of direct light were the two most important conditions to aid carotenoid stability.

Abstract Inaccurate labels on some e-cigarette products have prompted calls for routine testing to monitor product label integrity. The objective of this study was to compare label statements of commercial disposable/non-chargeable e-cigarette products for nicotine concentration and e-liquid volume with analytically verified levels. Commercial e-cigarette samples were analyzed for nicotine concentration (N = 51), e-liquid volume and total nicotine content (N = 39). Twenty-three of the 51 samples analyzed for nicotine deviated from their label statements by more than ± 10%. Deviations ranged from -50.1% to + 13.9%. Thirty of the 39 samples analyzed for e-liquid volume deviated from their label statements by more than ± 10%. Deviations ranged from -62.1% to + 13.3%. Only one brand listed total nicotine on the label. In thirty-one of the 39 samples, calculated total nicotine amount in e-liquid deviated from the amounts calculated from the label metrics by more than ± 10%. Deviations ranged from -66.8% to -1.43%. These findings underscore the need for regulatory enforcement of manufacturing quality control and product labeling practices to optimize the harm reduction potential and consumer experience associated with the use of e-cigarette products.

Background: Medial compartment osteoarthritis in young active patients presents a unique challenge with regard to joint preservation. Interventions, including cartilage restoration procedures, in the setting of high tibial osteotomy (HTO) have the potential to obviate or delay joint replacement if performed with a high degree of accuracy and avoidance of complications. Indications: The procedure is indicated in patients less than 65 years with isolated medial knee arthrosis, good range of motion, and no ligamentous instability. Technique Description: We present our technique for valgus producing opening wedge HTO with patient-specific instrumentation and implant with concomitant osteochondral allograft of the medial femoral condyle and tibial microfracture. Results: The goal of this intervention is to provide a minimally painful knee with durable (>10 year) outcome while minimizing the risk of perioperative complications including iatrogenic fracture and nonunion. Discussion/Conclusion: High tibial osteotomy with concomitant cartilage repair techniques can lead to high satisfaction and return to sport rates in appropriately selected patients. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Background and Aim: Clostridium toxins are widely used as medicinal agents. Many active metabolic enzymes, including sialidase (neuraminidase), hyaluronidase, and collagenase, contribute to the mechanism of action of these toxins. Sialidase from Clostridium perfringens recognizes and degrades sialic acid receptors in the host cell glycoprotein, glycolipid, and polysaccharide complexes. Sialic acid promotes the adhesion of various pathogens, including viruses, under pathological conditions. This study aimed to investigate the potential of C. perfringens sialidase protein to inhibit Newcastle disease virus (NDV) infection in ovo model. Materials and Methods: C. perfringens was characterized by molecular identification through polymerase chain reaction (PCR) and is cultured in a broth medium to produce sialidase. In addition, sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis was conducted to characterize the sialidase protein. In contrast, enzymatic activity and protein concentration were carried out using a neuraminidase assay kit and Bradford to obtain suitable active substances. Furthermore, embryonated chicken egg models were used to observe the toxicity of several sialidase doses. Then, the hemagglutination (HA) titer was obtained, and absolute quantitative reverse transcription–PCR assay was performed to measure the viral replication inhibitory activity of sialidase against NDV. Results: Each isolate had a specific sialidase gene and its product. The sialidase derived from C. perfringens could hydrolyze the sialic acid receptor Neu5Ac (2,6)-Gal higher than Neu5Ac (2,3)Gal in chicken erythrocytes, as observed by enzyme-linked lectin assay. A significant difference (p = 0.05) in the HA titer in the pre-challenge administration group at dosages of 375 mU, 187.5 mU, and 93.75 mU in the competitive inhibition experiment suggests that sialidase inhibits NDV reproduction. Quantification of infective viral copy confirmed the interference of viral replication in the pre-challenge administration group, with a significant difference (p = 0.05) at the treatment doses of 750 mU, 375 mU, and 46.87 mU. Conclusion: The potency of sialidase obtained from C. perfringens was shown in this study, given its ability to reduce the viral titer and copy number in allantoic fluids without adversely impacting the toxicity of the chicken embryo at different concentrations.

Objective: The Newcastle disease virus (NDV) is an infectious disease that causes very high eco¬nomic losses due to decreased livestock production and poultry deaths. The vaccine's ineffec¬tiveness due to mutation of the genetic structure of the virus impacts obstacles in controlling the disease, especially in some endemic areas. This study aimed to provide an alternative treatment for NDV infection by observing the viral replication inhibitor activity of Clostridium perfringens sialidase in primary chicken embryo fibroblast (CEF) cells. Materials and Methods: The virus was adapted in CEF monolayer cells, then collected thrice using the freeze–thaw method and stored at −20°C for the next step in the challenge procedure. C. perfringens crude sialidase was obtained, but it was further purified via stepwise elution in ion exchange using Q Sepharose® Fast Flow and affinity chromatography with oxamic acid agarose. The purified sialidase was tested for its toxicity, ability to breakdown sialic acid, stopping viral replication, and how treated cells expressed their genes. Results: According to this study, purified C. perfringens sialidase at dosages of 187.5, 93.75, and 46.87 mU effectively hydrolyzes CEF cells' sialic acid and significantly inhibits viral replication on the treated cells. However, sialidase dosages of 375 and 750 mU affected the viability of mono¬layer CEF cells. Interestingly, downregulation of toll-like receptor (TLR)3 and TLR7 (p < 0.05) in the sialidase-treated group indicates viral endocytosis failure. Conclusions: By stopping endocytosis and viral replication in host cells, sialidase from C. perfrin¬gens can be used as an alternative preventive treatment for NDV infection. [J Adv Vet Anim Res 2022; 9(2.000): 335-345]

Abstract Study on sialidases as antiviral agents has been widely performed, but many types of sialidase have not been tested for their antiviral activity. Pasteurella multocida NanB sialidase is one such sialidase that has never been isolated for further research. In this study, the activity of NanB sialidase was investigated in silico by docking the NanB sialidase of Pasteurella multocida to the Neu5Acα(2–6)Gal and Neu5Acα(2–3)Gal ligands. Additionally, some local isolates of Pasteurella multocida, which had the NanB gene were screened, and the proteins were isolated for further testing regarding their activity in hydrolyzing Neu5Acα(2–6)Gal and Neu5Acα(2–3)Gal. Silico studies showed that the NanB sialidase possesses an exceptional affinity towards forming a protein–ligand complex with Neu5Acα(2–6)Gal and Neu5Acα(2–3)Gal. NanB sialidase of Pasteurella multocida B018 at 0.129 U/mL and 0.258 U/mL doses can hydrolyze Neu5Acα(2–6)Gal and Neu5Acα(2–3)Gal better than other doses. In addition, those doses can inhibit effectively H9N2 viral binding to red blood cells. This study suggested that the NanB sialidase of Pasteurella multocida B018 has a potent antiviral activity because can hydrolyze sialic acid on red blood cells surface and inhibit the H9N2 viral binding to the cells.

Objective: The avian influenza virus (AIV) subtype H9N2 circulating in Indonesia has raised increasing concern about its impact on poultry and its public health risks. In this study, the H9N2 virus from chicken poultry farms in Java was isolated and characterized molecularly. Materials and Methods: Thirty-three pooled samples of chicken brain, cloacal swab, trachea, and oviduct were taken from multiple chickens infected with AIV in five regions of Java, Indonesia. The samples were isolated from specific pathogenic-free embryonated eggs that were 9 days old. Reverse transcription polymerase chain reaction and sequencing were used to identify H9N2 viruses. Results: This study was successful in detecting and characterizing 13 H9N2 isolates. The sequencing analysis of hemagglutinin genes revealed a 96.9%98.8% similarity to the H9N2 AIV isolated from Vietnam in 2014 (A/muscovy duck/Vietnam/LBM719/2014). According to the phylogenetic analysis, all recent H9N2 viruses were members of the lineage Y280 and clade h9.4.2.5. Nine of the H9N2 isolates studied showed PSKSSR↓GLF motifs at the cleavage site, while four had PSKSSR↓GLF. Notably, all contemporary viruses have leucine (L) at position 216 in the receptor-binding region, indicating that the virus can interact with a human-like receptor. Conclusion: This study described the features of recent H9N2 viruses spreading in Javas poultry industry. Additionally, H9N2 infection prevention and management must be implemented to avoid the occurrence of virus mutations in the Indonesian poultry industry. [J Adv Vet Anim Res 2021; 8(3.000): 423-434]

Despite the successes of immunotherapy, melanoma remains one of the deadliest cancers, therefore, the need for innovation remains high. We previously reported anti-melanoma compounds that work by downregulating spliceosomal proteins hnRNPH1 and H2. In a separate study, we reported that these compounds were non-toxic to Balb/C mice at 50 mg/kg suggesting their utility in in vivo studies. In the present study, we aimed to assess the efficacy of these compounds by testing them in A375 cell-line xenograft in nude athymic mice. Animals were randomized into four groups (n = 12/group): 10 mg/kg vemurafenib, and 25 mg/kg 2155-14 and 2155-18 thrice a week for 15 days along with a control group. The results revealed that both 2155-14 and 2155-18 significantly decreased the growth of A375 tumors, which was comparable to vemurafenib. These results were confirmed by tumor volume, weight, and histopathological examination. In conclusion, these results demonstrate the therapeutic potential of targeting spliceosomal proteins hnRNPH1 and H2.

PURPOSEThere are limited data on treatment and outcomes for acute lymphoblastic leukemia (ALL) among adolescents and young adults in sub-Saharan Africa. We describe a prospective observational cohort in Malawi.METHODSPatients age 15-39 years with newly diagnosed ALL at Kamuzu Central Hospital, Malawi, were enrolled from 2013 to 2019; follow-up was censored on December 2020. ALL diagnosis was confirmed on-site using immunohistochemistry and telepathology consultation involving pathologists in Malawi and the United States. All but four patients were treated with a modified pediatric-inspired regimen (Cancer and Leukemia Group B 10403 protocol). Key modifications included omission of asparaginase and no dose escalation for methotrexate.RESULTSOf 19 participants, the median age was 22 (range 15-36) years. Of the 15 patients who initiated treatment, 11 (73%) achieved remission after induction, one (7%) died during induction, two (13%) had refractory disease, and one (7%) absconded. No patients were lost to follow-up. Eventually, 10 of 11 patients (91%) with confirmed remission relapsed. The median duration of first remission was 10 (range 3-22) months. Twelve of 15 treated patients (80%) had died at the time of censoring. Among treated patients, the 12- and 24-month overall survival was 50% (95% CI, 23 to 72) and 17% (95% CI, 3 to 42), respectively. CNS involvement was associated with worse survival.CONCLUSIONIt is possible to treat adolescents and young adults with ALL in low-resource settings using a low-cost, pediatric-inspired regimen; however, outcomes are poor. Both cost and limitations in supportive care infrastructure limit intensive cytotoxic approaches such as asparaginase. Patient-reported outcomes are needed to understand the quality of life and cost-effectiveness. Critically, innovative, leap-frog therapies, such as monoclonal or bispecific antibodies, and feasible economic models for resource-limited settings are urgently needed.

Abstract Background Peer workers or “peers” (workers with past or present drug use experience) are at the forefront of overdose response initiatives, and their role is essential in creating safe spaces for people who use drugs (PWUD). Working in overdose response settings has benefits for peer workers but is also stressful, with lasting emotional and mental health effects. Yet, little is known about the stressors peer workers face and what interventions can be implemented to support them in their roles. Methods This project used a community-based sequential mixed-methods research design. Eight peer researcher-led focus groups (n = 31) were conducted between November 2018 and March 2019 to assess needs of peer workers. The transcripts were thematically coded and analysed using interpretative description. These results informed a survey, which was conducted (n = 50) in September 2019 to acquire quantitative data on peer workers’ perception of health, quality of life, working conditions and stressors. Frequency distributions were used to describe characteristics of participants. X 2 distribution values with Yates correction were conducted to check for association between variables. Results Five themes emerged from the focus groups that point to stressors felt by peer workers: (1) financial insecurity; (2) lack of respect and recognition at work; (3) housing challenges; (4) inability to access and/or refer individuals to resources; and (5) constant exposure to death and trauma. Consistent with this, the factors that survey participants picked as one of their “top three stressors” included financial situation, work situation, and housing challenges. Conclusion Peer workers are faced with a diversity of stressors in their lives which often reflect societal stigmatization of drug use. Recognition of these systemic stressors is critical in designing interventions to ease the emotional, physical and financial burden faced by peer workers.

Optical coherence tomography: chip promise The goal of an optical coherence tomography (OCT) imaging system that is integrated on a photonic chip has taken a step closer to reality. Elisabet Rank and coworkers from Austria have shown that arrayed waveguide gratings (AWGs), integrated-optical devices commonly used to separate different wavelength channels in an optical communications system, can be used to replace diffraction gratings in an OCT system. Several designs of silicon nitride AWGs with 256 channels in the near-infrared were fabricated and then tested in an OCT system which was able to capture in-vivo tomograms and angiography of the human eye’s retina, with comparable quality to a conventional system. The next stage of the OCT-on-a-chip research will focus on exploring the use of multimode interference structures, integrated photodiodes, and compact light sources.

Background: Repetitive transcranial magnetic stimulation (rTMS) is effective in treating depression; however, the effect on physical activity, sleep and recovery is unclear. This study investigated rTMS effect on physical activity and sleep through providing patients with a Fitbit and software apps; and reports the impact of rTMS on depression, anxiety and mental health recovery. Methods: Study design was a pre and post data collection without a control, with twenty-four participants with treatment-resistant depression (TRD). Measures used were Fitbit activity and sleep data, and patient-rated Recovering Quality of Life (ReQoL-20), Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder (GAD-7). Results: Response and remission rates were, respectively: 34.8% and 39% for PHQ-9; 34.8% and 47.8% for GAD-7. ReQoL-20 response and reliable improvement were 29.4% and 53%. PHQ-9, GAD-7 and ReQol-20 scores significantly improved, with large effect sizes. Analysis of Fitbit activity and sleep data yielded non-significant results. The Fitbit data machine learning model classified two levels of depression to 82% accuracy. Limitations: rTMS treatment was open-label and adjunct to existing antidepressant medication. No control group. Female patients were overrepresented. Conclusions: Improvements on the ReQoL-20 and aspects of sleep and activity indicate the positive impact of rTMS on the individual's real world functioning and quality of life. A wearable activity tracker can provide feedback to patients and clinicians on sleep, physical activity and depression levels. Further research could be undertaken through a sufficiently powered RCT comparing rTMS versus rTMS with use of a Fitbit, its software applications, and sleep and physical activity advice.

PURPOSELow health literacy is a leading cause of treatment abandonment among patients receiving cancer care at Kamuzu Central Hospital (KCH) in Malawi.METHODSWe developed cancer educational videos featuring Malawian providers and played them in the KCH oncology clinic. The videos addressed cancer-related topics, including disease biology, common myths, diagnostic procedures, treatment, side effects, and survivorship. After 6 months of implementation, we compared results from 50 pre- and postintervention surveys to assess change in cancer knowledge and care experience.RESULTSBoth pre- and postintervention cancer knowledge were good: a median of nine questions were answered correctly of 11 in both assessments. Despite the intervention, most continued to incorrectly identify cancer as an infection (pre: n = 26, 52%; post: n = 25, 50%; P = 1.0), although improvements were observed in patients' knowledge of correct actions for fever at home (pre: n = 38, 76%; post: n = 43, 86%; P = .31). Care experiences were overall good. Postintervention results indicate that more patients felt always listened to by their providers (pre: n = 18, 36%; post: n = 29, 58%; P < .01). However, we also noted a higher rate of patient dissatisfaction of care as more patients felt that they could not understand chemotherapy counseling (pre: n = 11, 22%; post: n = 22, 44%; P < .01). Assessments of video satisfaction indicate that patients found the videos very helpful in terms of understanding their disease (n = 47, 96%) and side effects (n = 48, 98%) and felt empowered to speak up with their providers (n = 46, 96%).CONCLUSIONStandardized education materials for patients that can be feasibly implemented throughout sub-Saharan Africa are urgently needed. Cancer educational videos are a low-cost way to educate and empower patients with cancer in resource-constrained settings although in-person discussions remain a crucial part of care.

Free, regular, and open elections are sought-after qualities of a liberal democracy. Reading electoral turnout as an indicator of political engagement, though, is a reductive reading and can obscure entrenched levels of political disengagement. This article considers the implications of Article 21, subsection one, of the United Nations Declaration of Human Rights (1948) as an assessment of political participation. There are three lines of investigation. First, the paper will examine the model of political engagement implied within Article 21 and its subsequent iterations. Second, theories of political participation are linked to a study of civic engagement within the British parliamentary system. Third, building upon these two arguments, the 2016 Brexit referendum is presented as a case study to demonstrate the limitations of a voter turnout measurement. Political participation must be continually (re)imagined, (re)constructed, and reflected upon otherwise we rely upon voting by numbers.

Abstract Plasma Epstein‐Barr virus (EBV) DNA measurement has established prognostic utility in EBV‐driven lymphomas, where it serves as a circulating tumor DNA marker. The value of plasma EBV measurement may be amplified in sub‐Saharan Africa (SSA), where advanced imaging and molecular technologies for risk stratification are not typically available. However, its utility in diffuse large B‐cell lymphoma (DLBCL) is less certain, given that only a subset of DLBCLs are EBV‐positive. To explore this possibility, we measured plasma EBV DNA at diagnosis in a cohort of patients with DLBCL in Malawi. High plasma EBV DNA at diagnosis (≥3.0 log10 copies/mL) was associated with decreased overall survival (OS) (P = .048). When stratified by HIV status, the prognostic utility of baseline plasma EBV DNA level was restricted to HIV‐positive patients. Unexpectedly, most HIV‐positive patients with high plasma EBV DNA at diagnosis had EBV‐negative lymphomas, as confirmed by multiple methods. Even in these HIV‐positive patients with EBV‐negative DLBCL, high plasma EBV DNA remained associated with shorter OS (P = .014). These results suggest that EBV reactivation in nontumor cells is a poor prognostic finding even in HIV‐positive patients with convincingly EBV‐negative DLBCL, extending the potential utility of EBV measurement as a valuable and implementable prognostic marker in SSA.

OBJECTIVE To promote equity in the Alpha Omega Alpha Honor Medical Society (AOA) selection process, clear and timely communication of eligibility criteria is needed. Herein, the authors describe and assess the effectiveness of a novel method for improving transparency in the AOA selection process while also teaching students key professional development skills. METHODS The authors hosted curriculum vitae (CV) workshops for interested medical students. One part of each session was dedicated to sharing information about AOA and its selection process, while the rest focused on teaching students how to build effective CVs. After the most recent session, students were asked to complete a survey about the effectiveness of the workshop. RESULTS Between 2019 and 2020, three CV workshops were hosted. Interest in the events was high, with approximately 15 to 30 first- and second-year medical students participating in each. Based on survey results, participants found the workshop helped them gain a better understanding of AOA eligibility and selection (100%, n = 10) and taught them key CV development skills (100%, n = 10). CONCLUSION These workshops are a novel approach to disseminating AOA eligibility criteria and can be employed by medical schools to promote transparency in the AOA selection process. They also give students the skills to craft CVs that will better prepare them for applying to residency and other academic opportunities. As such medical schools and AOA chapters should consider implementing a similar model at their institutions.

ObjectiveDespite advancements of intraoperative visualization, the difficulty to visually distinguish adenoma from adjacent pituitary gland due to textural similarities may lead to incomplete adenoma resection or impairment of pituitary function. The aim of this study was to investigate optical coherence tomography (OCT) imaging in combination with a convolutional neural network (CNN) for objectively identify pituitary adenoma tissue in an ex vivo setting.MethodsA prospective study was conducted to train and test a CNN algorithm to identify pituitary adenoma tissue in OCT images of adenoma and adjacent pituitary gland samples. From each sample, 500 slices of adjacent cross-sectional OCT images were used for CNN classification.ResultsOCT data acquisition was feasible in 19/20 (95%) patients. The 16.000 OCT slices of 16/19 of cases were employed for creating a trained CNN algorithm (70% for training, 15% for validating the classifier). Thereafter, the classifier was tested on the paired samples of three patients (3.000 slices). The CNN correctly predicted adenoma in the 3 adenoma samples (98%, 100% and 84% respectively), and correctly predicted gland and transition zone in the 3 samples from the adjacent pituitary gland.ConclusionTrained convolutional neural network computing has the potential for fast and objective identification of pituitary adenoma tissue in OCT images with high sensitivity ex vivo. However, further investigation with larger number of samples is required.

Introduction: Emergency medical services (EMS) systems can become impacted by sudden surges that can occur throughout the day, as well as by natural disasters and the current pandemic. Because of this, emergency department crowding and ambulance “bunching,” or surges in ambulance-transported patients at receiving hospitals, can have a detrimental effect on patient care and financial implications for an EMS system. The Centralized Ambulance Destination Determination (CAD-D) project was initially created as a pilot project to look at the impact of an active, online base hospital physician and paramedic supervisor to direct patient destination and distribution, as a way to improve ambulance distribution, decrease surges at hospitals, and decrease diversion status. Methods: The project was initiated March 17, 2020, with a six-week baseline period; it had three additional study phases where the CAD-D was recommended (Phase 1), mandatory (Phase 2), and modified (Phase 3), respectively. We used coefficients of variation (CV) statistical analysis to measure the relative variability between datasets (eg, CAD-D phases), with a lower variation showing better and more even distribution across the different hospitals. We used analysis of co-variability for the CV to determine whether level loading was improved systemwide across the three phases against the baseline period. The primary outcomes of this study were the following: to determine the impact of ambulance distribution across a geographical area by using the CV; to determine whether there was a decrease in surge rates at the busiest hospital in this area; and the effects on diversion. Results: We calculated the CV of all ratios and used them as a measure of EMS patient distribution among hospitals. Mean CV was lower in Phase 2 as compared to baseline (1.56 vs 0.80 P < 0.05), and to baseline and Phase 3 (1.56 vs. 0.93, P

Summary: Background: There are no clinical trials involving patients with diffuse large B-cell lymphoma (DLBCL) in sub-Saharan Africa since antiretroviral therapy (ART) for HIV became widely available in this region. We aimed to establish the safety and efficacy of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in patients with DLBCL in Malawi. Methods: This prospective, single-arm, non-randomised phase 1/2 clinical trial was done at Kamuzu Central Hospital Cancer Clinic (Lilongwe, Malawi). Eligible patients were adults (aged 18–60 years) with newly diagnosed DLBCL, an Eastern Cooperative Oncology Group performance status of 0–2, a CD4 count of 100 cells per μL or higher (if HIV-positive), measurable disease by physical examination, an absolute neutrophil count of 1000 × 109 cells per L or higher, a platelet count of 100 × 109 platelets per L or higher, a serum creatinine concentration of 132·60 μmol/L or less, a total bilirubin concentration of 34·21 μmol/L or less, a negative urine pregnancy test in women of childbearing potential, and no previous cytotoxic therapy. Pregnant or breastfeeding women, and individuals with CNS involvement from DLBCL, chronic hepatitis B infection (unless they were receiving tenofovir plus lamivudine), or any other comorbidities that would compromise the protocol objectives were excluded. Eligible patients received intravenous rituximab 375 mg/m2, cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, and vincristine 1·4 mg/m2 (maximum 2 mg/m2), and oral prednisone 100 mg or an equivalent drug every 21 days for up to six cycles. HIV-positive patients received concurrent ART. The primary outcome was the proportion of patients with National Cancer Institute Common Terminology Criteria for Adverse Events grade 3 or 4 non-haematological toxic effects or treatment-related deaths after six cycles of treatment. Secondary efficacy outcomes included the proportion of patients with a complete response after six cycles of treatment, and progression-free survival and overall survival at 12 months and 24 months. This trial is registered with ClinicalTrials.gov, NCT02660710. Findings: Between Aug 1, 2016, and July 31, 2019, 76 patients were screened, of whom 37 were eligible for the study and received R-CHOP. The median age of patients was 44 years (IQR 39–49) and 16 (43%) were women. Of all 37 patients, 20 (54%) had stage III or IV DLBCL, and the age-adjusted international prognostic index was 2 or higher in 25 (68%) patients. 27 (73%) patients were HIV-positive, with a median CD4 count of 208 cells per μL (IQR 144–422), and 21 (78%) patients were receiving ART at enrolment. Patients completed a median of six cycles (IQR 4–6). Grade 3 or 4 non-haematological toxic effects were reported in 12 (32% [95% CI 19–49]) patients, the most common of which was infection (nine [24%] patients). Of 16 (43%) deaths, ten were due to progression of DLBCL, four were due to treatment-related complications, and two were due to other causes, yielding a treatment-related mortality of 11% (95% CI 4–26%). Grade 3 or 4 neutropenia was observed in 26 (70%) patients, and grade 3 or 4 anaemia was observed in 11 (29%) patients. A total of 22 (59%) patients had a complete response. Overall survival was 68% (95% CI 50–80) at 12 months and 55% (37–70) at 24 months, and progression-free survival was 59% (42–73) at 12 months and 53% (35–68) at 24 months. Interpretation: R-CHOP could be feasible, safe, and efficacious in patients with DLBCL in Malawi. This is the first completed clinical trial on DLBCL focused on sub-Saharan African populations. Given the paucity of data on treatment of DLBCL from this region, these results could inform emerging cancer treatment programmes in sub-Saharan Africa. Funding: The University of North Carolina Lineberger Comprehensive Cancer Center.

In this report, we describe a case of atypical neuroleptic malignant syndrome (NMS) presenting with an isolated lesion in the splenium of the corpus callosum (ILSCC). There is a paucity of information regarding this topic within the literature and only 7 previous case reports have been published at the time of writing. To our knowledge, this case report is also the first to describe an atypical NMS variant in the context of an ILSCC. In this report, we describe the important considerations in formulating differential diagnosis for ILSCC and are the first report to propose a possible pathophysiological mechanism relating ILSCC with NMS.

Mechanical degradation due to brittle intermetallic compounds (IMCs) formed at the faying interface is a predominant deficiency in dissimilar metal joints. In copper/aluminum (Cu/Al) joints, additional defects (such as partially-bonded interfaces, porosity and cracks) lead to further weakened strength and lowered electrical conductivity. In this study, nickel‑phosphorus (Ni-P) coatings are deposited on Al to address these issues. With the aid of Ni-P coatings, the detrimental Cu-Al IMC is eliminated, a donut-shaped weld with a partially-bonded interface is evolved into an hourglass-shaped weld with a fully-bonded interface, while the porosity and cracks are inhibited. Numerical simulations indicate that, during the welding without Ni-P coating, the Al oxide aggravates the inhomogeneity of heat generation at the Cu/Al interface, promoting the formation of donut-shaped weld and defects. Microstructural characterization suggests that the Ni-P coatings obstruct the Cu-Al interdiffusion which results in CuAl2-free interfaces, while the amorphous Ni-P convert into eutectic microstructure composed of nanocrystalline Ni and fine Ni3P grains through a solid-state transformation. Using the Ni-P coatings, joints gain an improvement of 140% in lap-shear peak load and a 25-fold increase in lap-shear maximum elongation, as well as an 84% reduction in electrical resistance.

Previously, we showed that a hierarchy of spectrin cytoskeletal proteins maintains nodal Na+ channels (Liu et al., 2020). Here, using mice lacking β1, β4, or β1/β4 spectrins, we show this hierarchy does not function at axon initial segments (AIS). Although β1 spectrin, together with AnkyrinR (AnkR), compensates for loss of nodal β4 spectrin, it cannot compensate at AIS. We show AnkR lacks the domain necessary for AIS localization. Whereas loss of β4 spectrin causes motor impairment and disrupts AIS, loss of β1 spectrin has no discernable effect on central nervous system structure or function. However, mice lacking both neuronal β1 and β4 spectrin show exacerbated nervous system dysfunction compared to mice lacking β1 or β4 spectrin alone, including profound disruption of AIS Na+ channel clustering, progressive loss of nodal Na+ channels, and seizures. These results further define the important role of AIS and nodal spectrins for nervous system function.

New strategies are needed to mitigate the mycotoxin deoxynivalenol (DON) in feed and food products. Microbial DNA fragments were generated from a library of DON-tolerant microorganisms. These fragments were screened in DON-sensitive yeast strains for their ability to modify or transport DON. Fragments were cloned into a PCR8/TOPO vector, and recombined into the yeast vector, pYES-DEST52. Resulting yeast transformants were screened in the presence of 100 ppm DON. Transformants that were able to grow in the presence of DON were plated on a selective medium, and the cloned microbial DNA fragments were sequenced. BLAST queries of one microbial DNA fragment (4D) showed a high degree of similarity to an ABC transporter. A series of screening and inhibition assays were conducted with a transport inhibitor (propanol), to test the hypothesis that 4D is a mycotoxin transporter. DON concentrations did not change for yeast transformants expressing 4D. The ability of yeast transformants expressing 4D to transport DON was inhibited by the addition of propanol. Moreover, yeast transformants expressing a known efflux pump (PDR5) showed similar trends in propanol transport inhibition compared to 4D. Future work should consider mycotoxin transporters such as 4D to the development of transgenic plants to limit DON accumulation in seeds. Keywords: Deoxynivalenol, Transporter, Mycotoxin, Yeast, Microbial DNA fragment

Aim: This study aimed to identify genes encoding resistance to tetracycline (TE) and plasmid-mediated resistance to quinolones in Escherichia coli isolates from clinical cases of avian colibacillosis in Sukabumi, Indonesia. Materials and Methods: A total of 25 E. coli archive isolates were collected in 2013-2017 from clinical cases of avian colibacillosis in Sukabumi, Indonesia. All isolates were tested for TE and quinolone resistance using the disk diffusion method. TE -resistant E. coli isolates were screened for the presence of tet(A) and tet(B) genes by single polymerase chain reaction (PCR). The qnr(A), qnr(B), and qnr(S) genes were detected by multiplex PCR in quinolone-resistant E. coli isolates. Results: Result of this study shows that 19 of 25 (76%) E. coli isolates are resistant to oxytetracycline and 64% are resistant to TE; among them, 63.2% and 31.5% were positive tet(A) and tet(B), respectively. 13 out of 25 (52%) are resistant to ciprofloxacin and 36% are resistant to enrofloxacin either norfloxacin; among them, 61.6% were positive qnr(A), 7.7% were positive qnr(B), 23% were positive qnr(S), and 7.7% were positive both of qnr(A) and qnr(S). Conclusion: This study shows that a few pathogens of E. coli are resistant to TE and quinolone. The frequency of tet and qnr genes that are responsible for this resistance among avian pathogenic E. coli isolates in Sukabumi, Indonesia, was high.

Newcastle disease (ND) is an acute poultry disease caused by Paramyxovirus group. It has characteristic neurological symptoms, called torticollis. The molecular assay to find out the presence of viral genes in the brain can be an option in detecting ND virus infections since it penetrates brain barrier system. The purpose of this study was to identify ND viruses in the brain of chickens with torticollis symptoms, to analyze its phylogenetic and to characterize its virulence genetic code. Samples used were 12 dead chickens with historically had torticollis symptoms, obtained from poultry farms at several areas in West Java and Banten. Chicken brains were prepared for reverse transcriptasepolymerase chain reaction (RT-PCR) test. All positive samples then sequenced to obtain its nucleotide sequences from some of Fusion (F) genes analyzed its phylogenetic by comparing with Indonesian ND isolate virus from GenBank using Mega X software. The results of RT-PCR test showed that only one sample (Virus MSL.03) contained genes of ND virus. Based on homology tests and phylogenetic analysis, the virus belonged to subgenotype VIIh with an identical level of 95.34-95.86% when compared to several isolates from Indonesia. The MSL.03 ND virus has 112RRRKRF117 pattern in F0 indicatest its virulent category.

Abstract Plasmablastic lymphoma (PBL) clinical descriptions are scarce from sub-Saharan Africa (SSA) where both HIV and EBV are highly endemic. We identified 12 patients with pathologically confirmed PBL from a prospective cohort in Lilongwe, Malawi. Median age was 46 (range 26–71), seven (58%) were male, and six (50%) were HIV-positive. Eight patients were treated with CHOP and four with a modified EPOCH regimen. One-year overall survival was 56% (95% CI 24–79%), without clear differences based on HIV status. PBL occurs in Malawi in HIV-positive and HIV-negative individuals and can be treated successfully with curative intent, even in a low-resource setting in SSA.

The recent seismic code SNI 1726-2012 is significantly different compared to the older code SNI 1726-2002. The seismic hazard map was significantly changed and the level of maximum considered earthquake was significantly increased. Therefore, buildings designed according to outdated code may not resist the higher demand required by newer code. In this study, seismic performance of Hotel X in Kupang, Indonesia which was designed based on SNI-1726-2002 is investigated. The structure was analyzed using Nonlinear Time History Analysis. The seismic load used was a spectrum consistent ground acceleration generated from El-Centro 18 May 1940 North-South component in accordance to SNI 1726-2012. The results show that Hotel X can resist maximum considered earthquake required by SNI 1726-2012. The maximum drift ratio is 0.81% which is lower than the limit set by FEMA 356-2000 (2%). Plastic hinge damage level is also lower than the allowance in ACMC 2001.

Aim: This randomised controlled trial compared the same-session effects of two different school furniture configurations on printing legibility. Methods: A total of 30 school-age children with ambulatory cerebral palsy participated in this study. Each child provided one near-point printing sample of up to 34 letters while positioned on Mandal-type specialty school furniture and on standard school furniture. An assessor who was unaware of the intervention assignment scored printing errors. Results: No significant difference in legibility score mean values between the interventions was detected and the effect size was small. Conclusions: Compared with standard school furniture, the use of specialty school furniture did not lead to immediate gains in printing legibility and other printing performance areas for children with cerebral palsy. Further study of the influence of functional abilities, other contextual factors and the longer-term use of school furniture on handwriting performance is recommended. [ABSTRACT FROM AUTHOR]

Background/aim: Current handwriting assessment tools are standardised mostly on typically developing students. This study estimated the intrarater and interrater reliabilities of the adapted scoring criteria, titled the Minnesota Handwriting Assessment-Cerebral Palsy (MHA-CP), for evaluating the effectiveness of handwriting interventions for children with cerebral palsy. Methods: We scored two batches of 20 random samples each from 80 handwriting samples produced by 30 children with cerebral palsy using the MHA-CP to estimate the intrarater and interrater reliabilities, respectively. Results: Intraclass correlation coefficients exceeded 0.95 for both intrarater and interrater reliabilities for all quality subscales of the MHA-CP. Conclusions: The MHA-CP is shown to be a reliable measure of the manuscript handwriting performance of children with cerebral palsy who are in Grades 1 and 2. Further empirical testing is recommended to confirm its validity as an outcome measure for this population. [ABSTRACT FROM AUTHOR]

Glut1-deficiency syndrome is a severe neurodevelopmental disorder characterized by low brain glucose and epileptic seizures. Tanget al. show that in model mice, low Glut1 leads to defects of the brain vasculature, and that AAV9-based gene therapy at pre- or early-symptomatic stages prevents the defects and mitigates disease.

Electronic aids to daily living (EADL) are also known as environmental control systems (ECSs) or environmental control units (ECUs). Descriptive studies have been conducted regarding the benefit of EADL devices. These studies mostly focus on usage, qualify of life and satisfaction. There is a need for the study of functional benefits from EADL usage. This paper reports the development of Measure of Control using Electronic Aids to Daily Living (MCEADL), a tool that measures the functional changes specifically related to the use of EADL. We tested the psychometric qualities of MCEADL with 36 individuals (15 users and 21 non-users of EADL) with spinal cord injuries at or above C5/6 level. MCEADL was administered to the two groups twice, at a time interval of 4-8 weeks. The results of the study indicated that MCEADL has good internal consistency and good to very good test-retest reliability. In this paper, we discuss the possible applications of MCEADL as a clinical outcome measure or a program evaluation tool. Development of an outcome measure tool is an on-going process. Future research is necessary to examine the clinical utility of the measure with different diagnostic groups. [ABSTRACT FROM AUTHOR]

The focus on health, the environment and sustainable mobility make cycling a preferred choice as a mode of transportation. However, cyclists are very vulnerable in the event of a collision with a motor vehicle, especially in suburban and rural areas where the planning of the road is much less suitable for cycling. The general objective of this study is to document the risk factors related to the road environment for collisions between a cyclist and a motor vehicle in a less dense “regional environment” (small and medium sized communities). To analyze collision data, several methods were used: Kernel Density Estimation, Kulldorff spatial scan statistics, Poisson regression and logistic regression. Our results show that the spatial concentrations of collisions are mostly near the cycling infrastructure and intersections. There are some risk factors to explain a collision (intersection; presence of cycling infrastructure; urban areas; urban arteries) and to explain an injured cyclist (lack of cycling infrastructure; young cyclists (15 years and under); lighting conditions).In conclusion, our study on low-density environments produces results that converge with those of the existing literature on urban areas, but also shows some specific features. Similar risk factors to urban areas are intersections, urban arterials and the age of the victims and specific risk factors for low density areas are urban area, the presence of cycling infrastructure and lighting conditions (night).

BackgroundIncreasing access to conventional cancer treatment (CT) in low-income countries (LICs) is an important public health initiative to address the global burden of cancer. However, LICs have a high prevalence of use of traditional and complementary medicine (T&CM). It is important to consider the factors that influence a patient's choice to use T&CM, CT, or both for their cancer treatment.MethodsWe conducted focus groups among adult cancer patients in Lilongwe, Malawi to identify facilitators and barriers of T&CM use. Focus groups were recorded, transcribed, translated, and underwent thematic content analysis.ResultsCultural norms, T&CM access, T&CM success, and CT failure were all identified as facilitators to T&CM use. CT success and T&CM failure were identified as barriers. Access and norms appear to determine initial treatment selection, while treatment outcomes dictate continued use of T&CM or CT.ConclusionThis study identified a pragmatic and experience-based treatment selection process that aligns with the social cognitive theory of behavior and assists in comprehending the factors that influence T&CM use among cancer patients in a low resource setting.

Genome editing with CRISPR/Cas9 technology has advanced from the lab bench to clinical application with multiple trials underway. This article introduces a course-based undergraduate experience (CURE) combining CRISPR/Cas9 genome editing (using a modified two-plasmid system) and the animal model Caenorhabditis elegans. This CURE is designed to be a scalable, semester-long laboratory that will introduce the students to literature searches, molecular biology, experiment planning, microscopy, CRISPR bioethics discussion, and scientific writing. Here, students challenged themselves to endogenously tag the C. elegans gene zmp-4, a matrix metalloproteinase enzyme, with a fluorescent protein marker and successfully generated a new worm strain. The knock-in was confirmed with genotyping and imaging and will be available for use by the entire worm community.

Our work brings together theories and methodologies from public health and the learning sciences to develop a culturally relevant community-based intervention aimed at promoting healthy childhood development. We present our approach to personalising a community-based family intervention to prevent childhood obesity that aims to enhance participants’ agency. We argue that situating obesity within the individual’s multi-layered context not only provides a more robust understanding of the causes, but also generates sustainable options for promoting healthy lifestyles. Our findings emphasise the importance of a situated approach to learning that leverages social systems as a key resource for better navigating the environmental, material and ideational infrastructures that support healthy lifestyles.

BACKGROUND:The environmental and health impacts of reliance on solid fuels and traditional cookstoves in low-income countries have motivated the promotion of household cooking energy systems that use cleaner burning fuels and cookstoves that lead to reduced exposure to harmful pollutants. Little is known about adoption and use of such systems from the users' perspective. METHODS:We explored the facilitators and barriers to adoption and use of a private sector marketed household cooking energy system that uses sustainably produced biomass pellets and the cleanest burning fan micro-gasification stove currently available. We conducted 48 in-depth qualitative interviews in Gisenyi, Rwanda with decision-makers and cooks in 16 households that adopted the improved cookstove system and 8 non-adopter households. RESULTS:Reported facilitators and barriers to adoption and non-adoption, as well as use and non-use were complex, and in some cases, contradictory. Some adopters noted that cleanliness and low smoke production were major facilitators to adoption and use, while other adopters and non-adopters said the cookstoves blackened and damaged cooking pots and produced excessive smoke. Our findings suggest that correct use of the stove mediates user experience. Cost was likewise reported as a facilitator among some adopters and a barrier among other adopters and non-adopters. Peer influence played a significant role as both a barrier and a facilitator to adoption and transcended other factors. Positive peer influence describing the cleanliness, affordability, and efficiency of the cookstove system encouraged adoption and use, while negative comments by peers regarding excessive smoke and damaged cooking pots discouraged adoption. Commentaries by some participants suggest that inadequate training and instruction may be primary causes of the discrepancies. CONCLUSION:Cost, cleanliness, communication among peer networks, and adequate training and instruction are important factors associated with the adoption and use of improved cookstoves and should be prioritized in the implementation of improved cookstove programs.

Isolated dislocations of the scaphoid are extremely uncommon injuries and are often associated with significant ligamentous failures. Since scaphoid dislocations typically present with associated carpal fractures, few cases of isolated dislocations of the scaphoid exist in the literature. The proposed treatment options in the literature range from closed reduction and casting to open reduction and internal fixation. We present the case of a 41-year-old male with an isolated scaphoid dislocation in whom open reduction and internal fixation was performed with K-wires. At five months follow-up, the patient had returned to work and all desired activities.

The title of this final report is “ Analysis Of service Quality In jakarta pavilion Taman Mini Indonesia Indah”. The background of this research is the decrease of service provide to tourist . Tourist destination should be able to give good service to the tourist. by giving good service, will creating satisfaction for tourist enjoying attraction and culture in the Jakarta pavilion Taman Mini Indonesia Indah The target of this research is to know about perception of tourist to the service quality of staff or guide in the pavilion Jakarta . Kinds of that are used are qualitative and quantitative, data source are primary data and secondary data, data collection by observation, deep interview, questionnaire and literary study. Technic of data analysis that is used descriptive qualitative and likert scale analysis. The result of the study is perception of tourist to the service quality of staff and guide in the Jakarta pavilion is netral which means is not good or not bad with average of all is 3,45 from 50 respondents. The suggestion that can be given to the management of pavilion Jakarta the effort to the quality of service to improve the staff and guides quality in Jakarta pavilion.

We present a combination of optical coherence tomography (OCT) and Raman spectroscopy (RS) for improved diagnosis and discrimination of different stages and grades of bladder cancer ex vivo by linking the complementary information provided by these two techniques. Bladder samples were obtained from biopsies dissected via transurethral resection of the bladder tumor (TURBT). As OCT provides structural information rapidly, it was used as a red-flag technology to scan the bladder wall for suspicious lesions with the ability to discriminate malignant tissue from healthy urothelium. Upon identification of degenerated tissue via OCT, RS was implemented to determine the molecular characteristics via point measurements at suspicious sites. Combining the complementary information of both modalities allows not only for staging, but also for differentiation of low-grade and high-grade cancer based on a multivariate statistical analysis. OCT was able to clearly differentiate between healthy and malignant tissue by tomogram inspection and achieved an accuracy of 71% in the staging of the tumor, from pTa to pT2, through texture analysis followed by k-nearest neighbor classification. RS yielded an accuracy of 93% in discriminating low-grade from high-grade lesions via principal component analysis followed by k-nearest neighbor classification. In this study, we show the potential of a multi-modal approach with OCT for fast pre-screening and staging of cancerous lesions followed by RS for enhanced discrimination of low-grade and high-grade bladder cancer in a non-destructive, label-free and non-invasive way.