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PurposePrevious studies have demonstrated that radiologists and other providers perceive maging to be higher than they actually are. Thus, pregnant patients were less likely to receive ionizing radiation procedures. While it is imperative to minimize fetal radiation exposure, clinicians must remember that diagnostic studies should not be avoided due to fear of radiation, particularly if the imaging study can significantly impact patient care. Although guidelines do exist regarding how best to image pregnant patients, many providers are unaware of these guidelines and thus lack confidence when making imaging decisions for pregnant patients. This study aimed to gather information about current education, confidence in, and knowledge about emergency imaging of pregnant women among radiology, emergency medicine, and OB/GYN providers.MethodsWe created and distributed an anonymous survey to radiology, emergency medicine, and OB/GYN providers to evaluate their knowledge and confidence in imaging pregnant patients in the emergent setting. This study included a questionnaire with the intent of knowing the correct answers among physicians primarily across the United States (along with some international participation). We conducted subgroup analyses, comparing variables by specialty, radiology subspecialty, and training levels. Based on the survey results, we subsequently developed educational training videos.Results108 radiologists, of which 32 self-identified as emergency radiologists, ten emergency medicine providers and six OB/GYN clinicians completed the survey. The overall correct response rate was 68.5%, though performance across questions was highly variable. Within our 18-question survey, four questions had a correct response rate under 50%, while five questions had correct response rates over 90%. Most responding physicians identified themselves as either "fairly" (58/124, 47%) or "very" (51/124, 41%) confident. Amongst specialties, there were differences in performance concerning the knowledge assessment (p = 0.049), with the strongest performance from radiologists. There were no differences in knowledge by training level (p = 0.4), though confidence levels differed significantly between attending physicians and trainees (p

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Abstract: In modern practice, imaging plays an integral role in the diagnosis, evaluation of extent, and treatment planning for lower extremity infections. This review will illustrate the relevant compartment anatomy of the lower extremities and highlight the role of plain radiographs, CT, US, MRI, and nuclear medicine in the diagnostic workup. The imaging features of cellulitis, abscess and phlegmon, necrotizing soft tissue infection, pyomyositis, infectious tenosynovitis, septic arthritis, and osteomyelitis are reviewed. Differentiating features from noninfectious causes of swelling and edema are discussed.

Imaging evaluation for lower extremity infections can be complicated, especially in the setting of underlying conditions and with atypical infections. Predisposing conditions are discussed, including diabetes mellitus, peripheral arterial disease, neuropathic arthropathy, and intravenous drug abuse, as well as differentiating features of infectious versus non-infectious disease. Atypical infections such as viral, mycobacterial, fungal, and parasitic infections and their imaging features are also reviewed. Potential mimics of lower extremity infection including chronic nonbacterial osteomyelitis, foreign body granuloma, gout, inflammatory arthropathies, lymphedema, and Morel-Lavallée lesions, and their differentiating features are also explored.

Artificial intelligence (AI) applications in breast imaging span a wide range of tasks including decision support, risk assessment, patient management, quality assessment, treatment response assessment and image enhancement. However, their integration into the clinical workflow has been slow due to the lack of a consensus on data quality, benchmarked robust implementation, and consensus-based guidelines to ensure standardization and generalization. Contrast-enhanced mammography (CEM) has improved sensitivity and specificity compared to current standards of breast cancer diagnostic imaging i.e., mammography (MG) and/or conventional ultrasound (US), with comparable accuracy to MRI (current diagnostic imaging benchmark), but at a much lower cost and higher throughput. This makes CEM an excellent tool for widespread breast lesion characterization for all women, including underserved and minority women. Underlining the critical need for early detection and accurate diagnosis of breast cancer, this review examines the limitations of conventional approaches and reveals how AI can help overcome them. The Methodical approaches, such as image processing, feature extraction, quantitative analysis, lesion classification, lesion segmentation, integration with clinical data, early detection, and screening support have been carefully analysed in recent studies addressing breast cancer detection and diagnosis. Recent guidelines described by Checklist for Artificial Intelligence in Medical Imaging (CLAIM) to establish a robust framework for rigorous evaluation and surveying has inspired the current review criteria.

Recent advancements in artificial intelligence (AI) and machine learning offer numerous opportunities in musculoskeletal radiology to potentially bolster diagnostic accuracy, workflow efficiency, and predictive modeling. AI tools have the capability to assist radiologists in many tasks ranging from image segmentation, lesion detection, and more. In bone and soft tissue tumor imaging, radiomics and deep learning show promise for malignancy stratification, grading, prognostication, and treatment planning. However, challenges such as standardization, data integration, and ethical concerns regarding patient data need to be addressed ahead of clinical translation. In the realm of musculoskeletal oncology, AI also faces obstacles in robust algorithm development due to limited disease incidence. While many initiatives aim to develop multitasking AI systems, multidisciplinary collaboration is crucial for successful AI integration into clinical practice. Robust approaches addressing challenges and embodying ethical practices are warranted to fully realize AI's potential for enhancing diagnostic accuracy and advancing patient care.

Yousef Almoghrabi,1,2,* Hussam Daghistani,1,2,* Hanouf A Niyazi,3,* Hatoon A Niyazi,3,* Hind AbdulMajed,3,* Noha A Juma,3,* Noura Daffa,3,* Noof R Helmi,3,* Mohammed W Al-Rabia,3,4,* Jawahir A Mokhtar,3,5,6,* Bandar Hasan Saleh,3,* Dalya M Attallah,5 Maram Matar,5 Hani Ahmed Shukri,5 Shahd A Moqaddam,5 Sara Alamoudi,5 Khalil K Alkuwaity,6,7,* Turki Abujamel,6,7,* Ahmad M Sait,2,7 Mohammed Mufrrih,7,8 Ibrahim A Al-Zahrani,7,8,* Stephen O’hagan,9 Mazen A Ismail,10,* Ohood S Alharbi,11,* Hattan Jamal Momin,12,* Ibrahim Mohammed Abu,13,* Abdelbagi Alfadil,3,4,* Karem Ibrahem3 1Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 2Regenerative Medicine Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 3Department of Clinical Microbiology and Immunology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 4Centre of Research Excellence for Drug Research and Pharmaceutical Industries, King Abdulaziz University, Jeddah, Saudi Arabia; 5Department of Clinical Microbiology Laboratory, King Abdulaziz University Hospital, Jeddah, 21589, Saudi Arabia; 6Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 7Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 8Special Infectious Agents Unit BSL-3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; 9Department of Chemistry, Manchester Institute of Biotechnology, The University of Manchester, Manchester, UK; 10Department of Medical Education, Faculty of Medicine, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 11Department of Microbiology and Parasitology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; 12Medical Service Center, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 13Department of Community Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, 21589, Saudi Arabia*These authors contributed equally to this workCorrespondence: Karem Ibrahem, Email kaibrahem@kau.edu.saBackground: This six-year retrospective study provides an in-depth analysis of the epidemiological and clinical patterns associated with Acinetobacter baumannii (A. baumannii) infections, focusing on age distribution, antibiotic resistance profiles, and specimen types.Aim: The research examines the incidence and characteristics of both non-Multi-Drug Resistant (non-MDR) and Multi-Drug Resistant (MDR) A. baumannii strains by reviewing patient records from January 2016 to December 2022.Methods: Through a statistical analysis, the study highlights the incidence rates across diverse age groups and explores the impact of antibiotic treatment regimens on infection outcomes. Additionally, it identifies the primary clinical specimen types for each strain, noting an association between non-MDR A. baumannii and midstream urine samples, while MDR A. baumannii strains were more frequently found in respiratory, wound, peripheral, and central line swaps/specimens.Results: The results indicate that in 2016, non-MDR A. baumannii infections were notably more frequent compared to MDR A. baumannii cases. However, a significant shift occurred in 2021 and 2022, with a marked decrease in non-MDR A. baumannii cases and an increase in MDR A. baumannii infections. Antibiotic susceptibility testing revealed that non-MDR strains were commonly tested against cefazolin, ceftazidime, ciprofloxacin, gentamicin, nitrofurantoin, oxacillin, piperacillin/tazobactam, and trimethoprim/sulfamethoxazole. In contrast, MDR strains were frequently tested against amikacin, cefepime, colistin, meropenem, imipenem, and tigecycline.Conclusion: This study enhances the understanding of A. baumannii clinical behaviour and resistance patterns, offering valuable insights to support future research and inform strategies for infectious disease management and control.Keywords: Acinetobacter baumannii, MDR, the epidemiological and clinical patterns

Margarita Dudina,1,2 Kirstine Kobberøe Søgaard,1,3 Søren Schou Olesen,3,4 Hans Linde Nielsen1,3 1Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, 9000, Denmark; 2Department of Clinical Microbiology, Aarhus University Hospital, Aarhus N, 8200, Denmark; 3Department of Clinical Medicine, Aalborg University, Aalborg, 9000, Denmark; 4Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, 9000, DenmarkCorrespondence: Margarita Dudina, Department of Clinical Microbiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Denmark, Email mardud@rm.dkPurpose: Routinely collected clinical data are a valuable resource for epidemiological research in infectious diseases. We examined the validity of the ICD-10 diagnosis code K75.0 for pyogenic liver abscess (PLA) from hospital discharge registries.Patients and Methods: This validation study was conducted in the North Denmark Region, using data from Aalborg University Hospital and the North Denmark Regional Hospital, along with their smaller regional satellite hospitals. The study period extended from January 1, 2010, to June 30, 2022, covering a catchment population of approximately 590,000 inhabitants. We identified patients with a first diagnosis (primary or secondary) of PLA (ICD-10 code K75.0) recorded in the Danish National Patient Registry and estimated the positive predictive value (PPV) of the PLA diagnosis using medical records as the reference standard. Subanalyses of PPV were conducted based on the department setting (emergency, medical, or surgical).Results: A total of 297 patients received an ICD-10 diagnosis code of K75.0 during the study period. Five (2.0%) patients were excluded due to initial hospitalization outside the North Denmark Region, and 67 (23%) were misclassified. The overall PPV for the K75.0 diagnosis code during the study period was 77% (95% CI: 72– 82%). The highest PPV, 88% (95% CI: 81– 93%), was observed in patients diagnosed in medical departments, while the lowest PPV, 56% (95% CI: 30– 80%), was observed in patients diagnosed in emergency wards. The PPV for surgical departments was 69% (95% CI: 61– 77%).Conclusion: The overall PPV of the ICD-10 diagnosis code K75.0 for PLA was 77%. Variability in PPVs across departments suggested differences in diagnostic accuracy, with medical departments demonstrating the highest PPV.Keywords: pyogenic liver abscess, hepatic abscess, epidemiology, validation, positive predictive value

Yaqoob Qaseem,1 Kirk Kohwa Hou,1,2 Moritz S Pettenkofer1 1Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, USA; 2Doheny Eye Institute, Los Angeles, CA, USACorrespondence: Moritz S Pettenkofer, Retina Division, Stein Eye Institute, University of California Los Angeles, 200 Stein Plaza Driveway, Los Angeles, CA, 90095, USA, Email mpettenkofer@mednet.ucla.eduPurpose: To examine response to faricimab in neovascular age-related macular degeneration (nARMD) refractory to traditional anti-vascular endothelial growth factor (anti-VEGF) agents.Patients and methods: Retrospective chart review was conducted on eyes with nARMD with persistent subretinal and/or intraretinal fluid despite previously receiving ≥ 15 injections with ≥ 2 different anti-VEGF agents. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) parameters were collected at baseline, initial post-injection visit, and most recent visit with OCT following last faricimab.Results: Nineteen eyes were included. Average logMAR BCVA was 0.47 ± 0.60 at baseline, 0.42 ± 0.47 at initial follow-up (p=0.38), and 0.51 ± 0.63 at final visit (p = 0.50). Average central subfield thickness (CST) was 310 ± 92 μm at baseline, 279 ± 88 μm at initial follow-up (p = 0.001), and 274 ± 100 μm at last visit (p < 0.001). 9 eyes (47%) achieved resolution of fluid at both initial and final follow-up visits.Conclusion: Faricimab mildly decreased CST and reduced fluid in some nARMD eyes refractory to traditional anti-VEGF agents but had minimal effect on BCVA.Keywords: anti-VEGF, choroidal neovascularization, faricimab, neovascular age-related macular degeneration

Shohei Kuniya,1 Yusuke Miyazawa,1 Ryuichi Sawa,2 Tamaki Nara,1,3 Shuko Nojiri,1,3 Tsuyoshi Asai,4 Kanako K Kumamaru,1,3,5 Morikuni Tobita1,3 1Department of Healthcare Innovation, Juntendo University Graduate School of Medicine, Tokyo, Japan; 2Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan; 3Medical Technology Innovation Center, Juntendo University, Tokyo, Japan; 4Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan; 5Department of Radiology, Juntendo University, Tokyo, JapanCorrespondence: Morikuni Tobita, Medical Technology Innovation Center, Juntendo University, 2-1-1 hongo, Bunkyo, Tokyo, 1138421, Japan, Tel +81-3-3814-5672, Fax +81-3-5802-1715, Email mtobita@juntendo.ac.jpPurpose: As the number of older adults in society increases, their social roles and networks, as well as their physical function, decrease. This study aimed to clarify the association between social networks and physical function among people aged ≥ 60 years in rural Thailand.Patients and Methods: This cross-sectional study was conducted in the Photharam District, Ratchaburi Province, Thailand. Participants were required to be at least 60 years old and be able to walk to the health center. Social networks were surveyed using the Thai version of Lubben Social Network Scores-6. Four physical function measures, namely hand grip strength, five-times-sit-to-stand test, timed up-and-go (TUG) test, and one-leg standing, were considered. Regression analysis was conducted with Lubben Social Network Scores-6 as the dependent variable and the four types of physical function as independent variables.Results: A total of 497 older adults aged 60 years or more were enrolled; 82 were males, and 412 were females. The mean Lubben Social Network Scores-6 was 14.9 ± 5.7. Only the TUG test was associated in a single and multiple regression analysis with the Lubben Social Network Scores-6 as the dependent variable and the four physical function assessments as independent variables.Conclusion: The TUG test assessed the smoothness of normal standing and walking, which are essential physical functions for maintaining a social network and meeting people. This suggests a relationship between physical function and social network.Keywords: Lubben Social Network Scores-6, social relationship, timed up-and-go test, aging

Abstract Background Shoulder pain and disability from rotator cuff tears remain challenging clinical problem despite advancements in surgical techniques and materials. To advance our understanding of injury progression and develop effective therapeutics using tissue engineering and regenerative medicine approaches, it is crucial to develop and utilize animal models that closely resemble the anatomy and display the pathophysiology of the human rotator cuff. Among various animal models, the rabbit shoulder defect model is particularly favored due to its similarity to human rotator cuff pathology. However, a standardized protocol for creating a massive rotator cuff defect in the rabbits is not well defined. Therefore, the objective of our study was to establish a robust and reproducible model of a rotator cuff defect to evaluate the regenerative efficacy of scaffolds. Results In our study, we successfully developed a rabbit model with a massive supraspinatus tendon defect that closely resembles the common rotator cuff injuries observed in humans. This defect involved a complete transection of the tendon, spanning 10 mm in length and encompassing its full thickness and width. To ensure stable scaffolding, we employed an innovative bridging suture technique that utilized a modified Mason-Allen suture as a structural support. Moreover, to assess the therapeutic effectiveness of the model, we utilized different scaffolds, including a bovine tendon extracellular matrix (ECM) scaffold and a commercial acellular dermal matrix (ADM) scaffold. Throughout the observation period, no scaffold damage was observed. Notably, comprehensive histological analysis demonstrated that the regenerative tissue in the tendon ECM scaffold group exhibited an organized and aligned fiber structure, indicating tendon-like tissue regeneration while the tissue in the ADM group showed comparatively less organization. Conclusions This study presents a comprehensive description of the implemented procedures for the development of a highly reproducible animal model that induces massive segmental defects in rotator cuff tendons. This protocol can be universally implemented with alternative scaffolds to investigate extensive tendon defects and evaluate the efficacy of regenerative treatments. The application of our animal model offers a standardized and reproducible platform, enabling researchers to systematically evaluate, compare, and optimize scaffold designs. This approach holds significant importance in advancing the development of tissue engineering strategies for effectively repairing extensive tendon defects.

Introduction: The compound 2,4 Dichlorophenoxyacetic acid (2,4-D) is present in most combinations of herbicides and is widely used by farmers in India, especially against weeds in cereal crops. Few self-poisoning cases have been reported worldwide, with guarded prognosis in most cases. Inadequate history regarding deliberate intoxication, indistinct clinical presentation, and unavailability of diagnostic facilities to detect and estimate the agent make it a significant concern in poisoning as it mimics one of the commonest poisoning which is organophosphorus poisoning. The therapy and management of this poisoning as well as prognosis of patients are not well described due to the paucity of cases in published literature.Case report: We present a case of 2,4-D poisoning with a successful clinical outcome and highlight the challenges faced in management. Our patient (A 41-year-old farmer) had a stormy clinical course in the hospital with acute kidney injury developing after a few days; he received supportive therapy along with renal replacement therapy in the form of hemodialysis. He however recovered completely and was well at follow-up. We also review the optimum management of this condition so that emergency medicine physicians and allied health personnel involved in caring for these patients can manage this effectively.Discussion: The toxicity of 2,4 D poisoning mimics the common organophosphorus poisoning in terms of symptoms. Nephrotoxicity has been described mainly due to tubular toxicity though this may manifest later in the course of hospitalization. Early initiation of alkaline diuresis not only augments the elimination of toxins but also prevents nephrotoxicity. The worsening toxin-induced acute kidney injury/acute renal failure should be promptly managed by hemodialysis, as it also helps in the elimination of 2,4-D.Conclusion: 2, 4-D poisoning remains a significant clinical challenge due to its non-specific presentation. This article contributes to the limited available literature on this potentially fatal condition highlighting the successful management of a severe case through a multi-modal approach involving alkaline diuresis, hemodialysis, and potentially corticosteroids. Further research is needed to elucidate the pathophysiology of 2,4-D toxicity and to develop specific antidotes.

Introduction: Glaucoma is a progressive optic neuropathy characterized by functional loss or optic nerve dysfunction which is one of the leading causes of irreversible but preventable blindness. The aim of the study was to determine which of the retinal nerve fiber layer and optic nerve head parameters are reliable markers of optic nerve damage in glaucoma suspects. Methods: Observational cross-sectional study of 250 patient’s including147 glaucoma suspect eyes, 103 normal eyes. All subjects underwent complete eye examination and imaging with the spectral domain optical coherence tomography (SD-OCT) cirrus-TM OCT (Carl Zeiss Meditec, Dublin, CA). Retinal nerve fiber layer (RNFL) and optic nerve head (ONH) OCT protocols were used to evaluate all study participants. The main outcome measures were the difference in OCT parameters among groups. Results: Study shows statistically significant difference in the average RNFL thickness, superior, nasal, inferior, temporal quadrants, rim area, cup volume, average cup to disc ratio (CDR), vertical CDR with P value

Background: Childhood Acute Lower Respiratory Tract Infection (ALRTI) remains an important public health problem in the developing world, with significant morbidity and mortality a challenge. An understanding of risk factors in the development of childhood ALRTI may offer clues to prevention of the disease; identify conditions that lead to progression to severe disease, complications and even death in a child receiving treatment. Aim: to determine risk factors for ALRTI among Under five children hospitalized. Methods: A prospective study of children aged 2-60 months admitted into hospital with diagnosis of pneumonia and bronchiolitis from November 2011 to September 2012 at the National Hospital, Abuja, Nigeria. With a questionnaire data on socio- demographic and potential risk factors for ALRTI were obtained. Results: A total of 50 children aged 2-60 months were enrolled, 92.0 % had pneumonia while 8.0% had bronchiolitis. 86.0% of pneumonia subjects were 24months and below, while all those with bronchiolitis were infants. 43(86.0%) of subjects were hospitalized in the rainy season. The weights for height z score was less than minus 2 in 12 (24.0 %) of the subjects. Significant risk factor for ALRTI was the use of kerosene and solid fuel for domestic cooking, 33 (66.0%), p value 0.0001; Mortality was four percent among the infants. We conclude that younger ageunder 24 months and exposure to hydrocarbon and biomass from indoor pollution was contributing risk factors for ALRTI in Under five children.

Background: Antiretroviral therapy is associated with improved survival among HIV-infected children. In Nigeria, HIV treatment scale up was extended to children over a decade ago. This poses new challenges of sustained quality care. Aim: To determine the outcomes for HIV infected children and factors that influenced retention in care at the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu. Methods: This was a study of HIV -infected children seen between September 2004 and October 2015 and at the Paediatric HIV clinic of the University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu. Data collected include socio-demographics, HAART regimen and outcomes. Data analysis were done with Statistical Package for Social Sciences (SPSS) version 19 (Chicago IL). Results: Five hundred and nineteen of 555 enrolled children with complete data were included in the data analysis. Two hundred and sixty-seven (51.4%) were females. Three hundred and thirty-nine participants (65.3%) were still in care, 12345 (23.7%) had been lost to follow up, or 22 (4.2%) dead while 35 (6.87%) were transferred out to other health facilities or into the adult ART clinic. Factors associated with retention in care were both parents being HIV positive (p

Objective: To determine the level of awareness, knowledge and practice of human immunodeficiency virus post exposure prophylaxis (HIV PEP) among paediatricians in Nigeria. Methodology: The study was a cross sectional questionnairebased survey conducted among paediatrcians that attended the Paediatric association of Nigeria annual scientific conference in 2015. Results: Most of the respondents (96%) were aware of the concept HIV PEP. The scores on knowledge of PEP for all the respondents ranged from 18% to 91 % with a mean score of 46.5 ± 14.1%. There was no significant difference between the performance of those who had received training on HIV PEP (48.0 ± 13.2%) and those who had not (45.1 ± 14.8%), p = 0.21, t =1.26. Ninety one (60.7%) of the respondents had been exposed to percutaneous injury during work. Thirty (33%) of the exposed paediatricians did not know the patient’s HIV status and only 10 (11%) received PEP, with only 7 (7.7%) of them completing the PEP for 4 weeks Conclusion: Despite the high level of HIV PEP awareness, there was an unacceptable high rate of occupational exposures and poor knowledge of HIV PEP among Paediatricians. Additionally, there was a low uptake of HIV PEP services amongst exposed Paediatricians in Nigeria. There is need for urgent action to curb this trend.

This report is on holoprosencephaly (HPE) sequence with other clinical and radiographic anomalies of other organs. This condition which has never been reported in Yenagoa, an oil rich Niger Delta Region was observed simultaneously in two neonates within a period of two months at different hospitals in this area. The inhabitants who include pregnant mothers with their fetuses are predisposed to health challenges associated with the exposure to toxic chemicals derived from environmental degradation and pollution due to oil spillage/processing. This report is therefore aimed at providing a description of HPE associated with varying multi-systemic conditions in order to motivate researches on prevalence of congenital anomalies and induce support in ensuring appropriate health care services. The approach to clinical evaluation and experience on diagnostic evidence is discussed. The importance of karyotyping which could not be carried out cannot be overlooked. However, the clinical and radiological features suggested the diagnoses of HPE Sequence. Holoprosencephaly (HPE) occurs due to a primary defect in prechordal mesoderm, resulting in fusion anomaly of the forebrain with also varying degrees of midline facial development anomalies. Although, HPE could be isolated, in certain conditions, it may occur in combination with other anomalies of the central nervous system and other organs. The causes of HPE are generally unknown but genetic and environmental factors have been implicated. Recognizing the prognosis in management, considerations vary from being conservative to reconstructive surgeries. The first neonate died on the 13th day of life, while the second neonate is still alive on supportive management of anticonvulsants and nutritional support on the 11th week of life at the time of writing this report.

Kun-Kun Qiang,1,2 Qing-Yun Song1,2 1Department of Diagnostic Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China; 2Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Chengdu, People’s Republic of ChinaCorrespondence: Qing-Yun Song, Department of Diagnostic Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People’s Republic of China, Email huaxi2chaoshengsqy@163.comIntroduction: Uterine artery pseudoaneurysm (UAP) is a rare cause of late postpartum hemorrhage. Insufficient understanding of this condition among clinicians may result in delayed diagnosis and treatment, potentially leading to incorrect interventions and poor prognosis, including fatal hemorrhage and even necessitating hysterectomy in severe cases.Case Report: The patient, a 41-year-old woman with a history of three pregnancies and two deliveries, underwent cesarean section and subsequently experienced persistent small amounts of vaginal bleeding for a duration of two months. Transvaginal ultrasonography revealed a hypoechoic mass in the cervix that was initially misdiagnosed as a cervical fibroid. Approximately 12 h prior to admission, she experienced an episode of acute vaginal bleeding of significant intensity. Emergency transvaginal ultrasound demonstrated an intrauterine mass located in the posterior wall of the cervix with swirling blood flow, exhibiting a to-and-fro pattern. The mass was connected to the left uterine artery adjacent to the cervix through a tear measuring approximately 0.5 cm in diameter. Emergency bilateral uterine artery embolization was performed. After a follow-up period of ten months, there was no recurrence of abnormal vaginal bleeding, and subsequent ultrasound examination confirmed the complete resolution of the cervical lesions.Conclusion: The findings of this case suggest that the UAP undergoes a dynamic process. In the early stages, the lesion may manifest as a small hypoechoic or anechoic area within the myometrium. Color Doppler imaging might not reveal blood flow signals within the lesion, potentially leading to misdiagnosis as other common uterine lesions such as fibroids or cysts. However, considering the close association between UAP and the uterine artery, meticulous observation of the relationship between the uterine artery and its branches is crucial for identifying myometrial lesions to facilitate early detection of UAP and minimize misdiagnosis.Keywords: uterine artery, pseudoaneurysm, postpartum hemorrhage, ultrasound, uterine artery embolization

Abstract Background Therapeutic ceiling of care is the maximum level of care deemed appropiate to offer to a patient based on their clinical profile and therefore their potential to derive benefit, within the context of the availability of resources. To our knowledge, there are no models to predict ceiling of care decisions in COVID-19 patients or other acute illnesses. We aimed to develop and validate a clinical prediction model to predict ceiling of care decisions using information readily available at the point of hospital admission. Methods We studied a cohort of adult COVID-19 patients who were hospitalized in 5 centres of Catalonia between 2020 and 2021. All patients had microbiologically proven SARS-CoV-2 infection at the time of hospitalization. Their therapeutic ceiling of care was assessed at hospital admission. Comorbidities collected at hospital admission, age and sex were considered as potential factors for predicting ceiling of care. A logistic regression model was used to predict the ceiling of care. The final model was validated internally and externally using a cohort obtained from the Leeds Teaching Hospitals NHS Trust. The TRIPOD Checklist for Prediction Model Development and Validation from the EQUATOR Network has been followed to report the model. Results A total of 5813 patients were included in the development cohort, of whom 31.5% were assigned a ceiling of care at the point of hospital admission. A model including age, COVID-19 wave, chronic kidney disease, dementia, dyslipidaemia, heart failure, metastasis, peripheral vascular disease, chronic obstructive pulmonary disease, and stroke or transient ischaemic attack had excellent discrimination and calibration. Subgroup analysis by sex, age group, and relevant comorbidities showed excellent figures for calibration and discrimination. External validation on the Leeds Teaching Hospitals cohort also showed good performance. Conclusions Ceiling of care can be predicted with great accuracy from a patient’s clinical information available at the point of hospital admission. Cohorts without information on ceiling of care could use our model to estimate the probability of ceiling of care. In future pandemics, during emergency situations or when dealing with frail patients, where time-sensitive decisions about the use of life-prolonging treatments are required, this model, combined with clinical expertise, could be valuable. However, future work is needed to evaluate the use of this prediction tool outside COVID-19.

Yiwang Zhou,1 Madeline R Horan,2 Samira Deshpande,1 Kirsten K Ness,2 Melissa M Hudson,3 I-Chan Huang,2,&ast; Deokumar Srivastava1,&ast; 1Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA; 2Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA; 3Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA&ast;These authors contributed equally to this workCorrespondence: Yiwang Zhou, Department of Biostatistics, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mail Stop 768, Memphis, Tennessee, TN 38105, USA, Tel +1 901-595-6736, Email yiwang.zhou@stjude.orgPurpose: Childhood cancer survivors experience interconnected symptoms, patterns of which can be elucidated by network analysis. However, current symptom networks are constructed based on the average survivors without considering individual heterogeneities. We propose to evaluate personal symptom network estimation using the Ising model with covariates through simulations and estimate personal symptom network for adult childhood cancer survivors.Patients and Methods: We adopted the Ising model with covariates to construct networks by employing logistic regressions for estimating associations between binary symptoms. Simulation experiments assessed the robustness of this method in constructing personal symptom network. Real-world data illustration included 1708 adult childhood cancer survivors from the St. Jude Lifetime Cohort Study (SJLIFE), a retrospective cohort study with prospective follow-up to characterize the etiology and late effects for childhood cancer survivors. Patients’ baseline symptoms in 10 domains (cardiac, pulmonary, sensation, nausea, movement, pain, memory, fatigue, anxiety, depression) and individual characteristics (age, sex, race/ethnicity, attained education, personal income, and marital status) were self-reported using survey. Treatment variables (any chemo or radiation therapy) were obtained from medical records. Personal symptom network of 10 domains was estimated using the Ising model, incorporating individual characteristics and treatment data.Results: Simulations confirmed the robustness of the Ising model with covariates in constructing personal symptom networks. Real-world data analysis identified age, sex, race/ethnicity, education, marital status, and treatment (any chemo and radiation therapy) as major factors influencing symptom co-occurrence. Older childhood cancer survivors showed stronger cardiac-fatigue associations. Survivors of racial/ethnic minorities had stronger pain-fatigue associations. Female survivors with above-college education demonstrated stronger pain-anxiety associations. Unmarried survivors who received radiation had stronger association between movement and memory problems.Conclusion: The Ising model with covariates accurately estimates personal symptom networks. Individual heterogeneities exist in symptom co-occurrence patterns for childhood cancer survivors. The estimated personal symptom network offers insights into interconnected symptom experiences.Keywords: bootstrap testing, individual heterogeneity, Ising model, network analysis, sociodemographic

Xian-Ping Yang,1,&ast; Ying-Yao Liu,2,&ast; Cai-Yun Zhang,3 Kai-Kai Huang,1 Shan-Shan Han,1 Bao-Ying Liang,1 Ying Lin1 1Department of Dermatology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, Guangdong, People’s Republic of China; 2The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People’s Republic of China; 3Department of Dermatology, Dongguan Traditional Chinese Medicine Hospital, Dongguan, Guangdong, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ying Lin, Department of Dermatology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), No. 111 Dade Road, Guangzhou, Guangdong, 510120, People’s Republic of China, Email lin19791226@gzucm.edu.cnAim: Atopic dermatitis (AD) often accompanies skin infections, and bacterial skin infections often cause persistent and worsening symptoms. In this study, we explored the key changes in the microbiota of AD patients, as well as the effects of different ages and the severity of rash on changes in the microbiota.Patients and Methods: A total of 95 AD patients and 77 healthy volunteers were recruited. The AD patients were divided into three groups based age and three groups according to the EASI score. Microorganisms collected from the skin were analyzed through 16S rRNA gene sequencing, revealing species diversity via α and β diversity analyses. Species compositions were compared at the phylum and genus levels. The significance of skin microbiota at the genus level was assessed using the random forest algorithm. Finally, the impact of relationships between different microbial communities on the microbial community composition and the pathogenesis of AD was explored using Pearson correlation coefficients.Results: The species diversity of the skin microbiota in the AD group significantly decreased. Compared with that in the healthy volunteers (HV) group, the bacterial diversity in the two groups of samples significantly differed. Staphylococcus dominated the bacterial communities, and as AD symptoms gradually worsened, the abundance of Staphylococcus gradually increased. Among all bacterial genera with a relative abundance greater than 1%, Staphylococcus showed a negative correlation with other genera, and showed significant consistency in specimens from different age groups.Conclusion: Changes in the abundance of Staphylococcus in the skin bacterial colonies are the main cause of AD. Brevundimonas, Paracoccus, Corynebacterium, and Veillonella may serve as characteristic biomarkers for AD. These results indicate that altering the microbiota composition of the skin may aid in the treatment of AD.Keywords: atopic dermatitis, skin bacterial colony, 16S rRNA gene sequencing

Kelly K Bisignano, Jennyffer D Smith, Wendy W Harrison Department of Clinical Sciences College of Optometry, University of Houston, Houston, TX, USACorrespondence: Wendy W Harrison, Email wwharris@central.uh.eduPurpose: Local retinal oxygen saturation is a research technique, which has the potential as a biomarker for diabetes. However, normative data has not been established. This study examined differences in oxygen saturation around the macula and characterizes the relationship between age, race, refractive error (RE), sex, blood pressure (BP), prediabetic status and oxygen saturation.Methods: Fifty-nine subjects aged 22– 69 (38.8 ± 14.7 years) were included who were racially diverse and with equal gender distribution. None had eye disease. Oxygen saturation was taken with the Zilia Ocular in 4 locations around the macula 3.1 degrees from the fovea and they were also averaged. BP, RE, and HbA1c were noted. Regression analyses for oximetry and other factors were completed as were t-tests with multiple comparison corrections.Results: There were significant variations in oximetry measures by race, with higher pigmentation levels associated with lower oximetry values (p < 0.01). There was no relationship between oximetry and sex (p = 0.34), RE (p = 0.67), BP (systolic p = 0.61, diastolic p = 0.71) nor prediabetic status (p = 0.87). Oximetry was associated with age when controlling for race (P < 0.002). Nasal-temporal variations showed nasal oximetry to higher than temporal measures (P < 0.01).Conclusion: This study revealed race/pigmentation is an important influence on oximetry measures. Retinal location also caused variations, likely due to proximity to larger vessels nasally. No differences in sex, RE nor BP were observed to alter local oxygen saturation. However, age was correlated when considered with race. This study will inform our future work in different disease states and is an important first step in evaluating this technology.Plain Language Summary: This study evaluates a new research instrument (Zilia Ocular) which measures how much oxygen is in the very small blood vessels of the retina. Our group wanted to evaluate healthy people to find out if the measurements the instrument takes are different in different sexes, ages, races, glasses prescriptions and blood pressures. We also looked at if they were changed in people with prediabetes and if it is different in different locations on the retina. We found that the measures are different in different races and ages. The measures also change with location in the eye. The other factors did not change the measurements of oxygen saturation on this instrument. We need to know this information because we want to detect changes in the retina in diabetes in diverse patient groups; however, we need to know about normal variations to better understand and collect that data.Keywords: oximetry, oxygen saturation, prediabetes, refractive error, blood pressure

To date, studies investigating radiomics-based predictive models have tended to err on the side of data-driven or exploratory analysis of many thousands of extracted features. In particular, spatial assessments of texture have proven to be especially adept at assessing for features of intratumoral heterogeneity in oncologic imaging, which likewise may correspond with tumor biology and behavior. These spatial assessments can be generally classified as spatial filters, which detect areas of rapid change within the grayscale in order to enhance edges and/or textures within an image, or neighborhood-based methods, which quantify gray-level differences of neighboring pixels/voxels within a set distance. Given the high dimensionality of radiomics datasets, data dimensionality reduction methods have been proposed in an attempt to optimize model performance in machine learning studies; however, it should be noted that these approaches should only be applied to training data in order to avoid information leakage and model overfitting. While area under the curve of the receiver operating characteristic is perhaps the most commonly reported assessment of model performance, it is prone to overestimation when output classifications are unbalanced. In such cases, confusion matrices may be additionally reported, whereby diagnostic cut points for model predicted probability may hold more clinical significance to clinical colleagues with respect to related forms of diagnostic testing.

Introduction: Image segmentation is an important process for quantifying characteristics of malignant bone lesions, but this task is challenging and laborious for radiologists. Deep learning has shown promise in automating image segmentation in radiology, including for malignant bone lesions. The purpose of this review is to investigate deep learning-based image segmentation methods for malignant bone lesions on Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and Positron-Emission Tomography/CT (PET/CT). Method: The literature search of deep learning-based image segmentation of malignant bony lesions on CT and MRI was conducted in PubMed, Embase, Web of Science, and Scopus electronic databases following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A total of 41 original articles published between February 2017 and March 2023 were included in the review. Results: The majority of papers studied MRI, followed by CT, PET/CT, and PET/MRI. There was relatively even distribution of papers studying primary vs. secondary malignancies, as well as utilizing 3-dimensional vs. 2-dimensional data. Many papers utilize custom built models as a modification or variation of U-Net. The most common metric for evaluation was the dice similarity coefficient (DSC). Most models achieved a DSC above 0.6, with medians for all imaging modalities between 0.85–0.9. Discussion: Deep learning methods show promising ability to segment malignant osseous lesions on CT, MRI, and PET/CT. Some strategies which are commonly applied to help improve performance include data augmentation, utilization of large public datasets, preprocessing including denoising and cropping, and U-Net architecture modification. Future directions include overcoming dataset and annotation homogeneity and generalizing for clinical applicability.

ObjectivesTo evaluate the performance of machine learning-augmented MRI-based radiomics models for predicting response to neoadjuvant chemotherapy (NAC) in soft tissue sarcomas.MethodsForty-four subjects were identified retrospectively from patients who received NAC at our institution for pathologically proven soft tissue sarcomas. Only subjects who had both a baseline MRI prior to initiating chemotherapy and a post-treatment scan at least 2 months after initiating chemotherapy and prior to surgical resection were included. 3D ROIs were used to delineate whole-tumor volumes on pre- and post-treatment scans, from which 1708 radiomics features were extracted. Delta-radiomics features were calculated by subtraction of baseline from post-treatment values and used to distinguish treatment response through univariate analyses as well as machine learning-augmented radiomics analyses.ResultsThough only 4.74% of variables overall reached significance at p ≤ 0.05 in univariate analyses, Laws Texture Energy (LTE)-derived metrics represented 46.04% of all such features reaching statistical significance. ROC analyses similarly failed to predict NAC response, with AUCs of 0.40 (95% CI 0.22-0.58) and 0.44 (95% CI 0.26-0.62) for RF and AdaBoost, respectively.ConclusionOverall, while our result was not able to separate NAC responders from non-responders, our analyses did identify a subset of LTE-derived metrics that show promise for further investigations. Future studies will likely benefit from larger sample size constructions so as to avoid the need for data filtering and feature selection techniques, which have the potential to significantly bias the machine learning procedures.

Limited research has examined the mental health of individuals experiencing homelessness in Hawai'i, which bears the nation's second highest homelessness rate. Mental health, substance use, treatment need, and health data were collected from 162 unhoused individuals in Hawai'i County by visiting community locations where they congregate (e.g., beaches, vacant buildings). 77% of participants were Native Hawaiian/Pacific Islander (NH/PI) with participants demonstrating severe rates of mental and substance use disorders including 57% experiencing major depressive disorder (MDD), 56% experiencing generalized anxiety disorder (GAD), and 64%, 74%, and 12% experiencing alcohol, methamphetamine, and opioid use disorders, respectively-heightening overdose risk. Treatment need was high (62%) but health was poor (85% reporting fair/poor health), with MDD and GAD predicting reduced general health (p

Objetivo: Descrever as tendências no diagnóstico de síndrome mielodisplásica no Brasil entre o período de 2014 e 2023 e sua associação com variáveis demográficas, sexo e faixa etária. Metodologia: Refere-se a um estudo documental quantitativo, retrospectivo e descritivo, realizado com base em informações referentes aos casos de síndrome mielodisplásica diagnosticados no período de 2019 a 2023, disponíveis no banco de dados do Sistema de Informações Ambulatoriais (SIA), no banco de informações em saúde TABNET (DATASUS). Nesta pesquisa, foram utilizadas as seguintes variáveis: sexo e faixa etária, fazendo uma comparação entre regiões do país e casos por ano. Resultados: Houve um aumento de 117,8% nos diagnósticos de Síndrome Mielodisplásica (SMD) no Brasil, de 450 casos em 2014 para 980 casos em 2023. Em se tratando da distribuição por sexo, em 2023, 54,1% dos casos diagnosticados eram homens (530 casos) e 45,9% eram mulheres (450 casos). Já na análise da faixa etária, nota-se que a maioria dos casos ocorreu em indivíduos acima de 60 anos, que representaram 65% dos diagnósticos em 2023. A faixa etária de 40 a 59 anos teve 25% dos casos, enquanto os indivíduos com menos de 40 anos representaram 10% dos diagnósticos. A região Sudeste apresentou o maior número de casos em relação ao total (40%), enquanto a menor taxa é da região Norte (5%). Discussão: Este estudo epidemiológico apresentou relevancia por fortalecer o direcionamento assertivo aos cuidados de saúde em pessoas com Síndrome Mielodisplásica (SMD), sobretudo a partir da identificação da maior incidência em pessoas do sexo masculino e acima de 60 anos. Aproximadamente 65% dos pacientes com SMD têm mais de 60 anos de idade no momento do diagnóstico e a taxa de incidência dobra a cada década acima dos 40 anos de idade. Apresentando um curso clínico extremamente variável, ela se enquadra em um espectro que varia desde um curso estável da doença ao longo de 10 ou mais anos, até evolução para morte, com evolução acelerada entre alguns meses subsequente à complicações de citopenia ou transformação leucêmica. Além disso, o fato de ter um aumento no número de casos entre 2014 e 2023, sendo a maior quantidade de pacientes no Sudeste, demonstra que a SMD é uma doença que necessita de estratégias de prevenção e diagnóstico precoce. Conclusão: Diferenças étnicas e influências regionais desempenham um papel significativo na patogênese e estabelecimento da Síndrome Mielodisplásica. Sendo assim, fatores genéticos, fatores étnicos, ocupacionais, de estilo de vida e ambientais contribuem para a história natural e desenvolvimento da síndrome em questão. A compreensão desses aspectos é crucial para o desenvolvimento de estratégias eficazes de prevenção, diagnóstico precoce e manejo da SMD, visando melhorar a qualidade de vida dos pacientes e otimizar os recursos de saúde.

Introdução: A anemia grave leva a hipóxia tecidual e ativação de mecanismos compensatórios, com aumento da frequência cardíaca (FC) e frequência respiratória (FR). Como em humanos, a transfusão sanguínea com concentrado de hemácias em cães é uma terapia suporte enquanto se busca o diagnóstico ou o tratamento se torne efetivo. Objetivo: O objetivo do presente estudo foi analisar os parâmetros: frequência cardíaca (FC), frequência respiratória (FR), temperatura retal (T°C) e coloração de mucosas (CM) pré e pós-transfusionais em cães com anemia de causas diversas. Material e métodos: Foi realizada análise retrospectiva das fichas de acompanhamento de transfusões de concentrado de hemácias em um Hospital Veterinário no período de julho de 2023 a junho de 2024. As transfusões foram realizadas em cães de várias raças, idades e peso corpóreo. A hemoglobina destes pacientes variou de 1,5 a 5g/dL. Foram analisados os registros de FC, FR, T°C e CM pré-transfusionais (T1) e pós-transfusionais (T2) de 149 transfusões, sendo que foram retirados do estudo quatro transfusões devido a reação transfusional (três reações febril não hemolítica e uma sobrecarga de volume (TACO)), totalizando 145 transfusões avaliadas. Os dados foram submetidos ao teste t pareado ou de Mann Whitney na dependência da avaliação da normalidade dos dados, considerando p < 0,05 como significativo. Resultados: Houve redução significativa na frequência cardíaca e frequência respiratória após as transfusões: FC T1: 134,9 ± 29,6 bpm; FC T2: 104,3 ± 26,1bpm; FR T1: 28 (mín: 8, max: 80) mpm; FR T2: 24 (mín: 8, max: 80) mpm. Não houve diferença na temperatura retal, T1: 37,7ºC (min: 33,4; max: 40,0) e T2: 37,9ºC (min: 33,0; max:39,7). Das 145 transfusões, houve melhora na CM em 97 transfusões (67%); não houve alterações na CM em 41 transfusões (28%); em 7 transfusões (5%) não foi possível avaliar a mucosa por fatores como agressividade dos animais. Discussão: A redução na FC e FR após as transfusões confirma a eficácia do procedimento na diminuição da hipóxia tecidual e redução na ativação de mecanismos compensatórios. A T°C ao longo das transfusões não apresentou alterações significativas, mostrando que a utilização de sangue refrigerado (à 4°C) em cães não ocasiona diminuição da temperatura corporal. A melhora da coloração das mucosas pode sinalizar o aumento do número de hemácias e/ou diminuição da vasoconstrição periférica. Conclusão: Pode-se concluir com os presentes dados que o acompanhamento da transfusão sanguínea com FC, FR, CM e temperatura é importante para detecção precoce de reação transfusional, mas também para avaliação da melhora dos parâmetros clínicos dos pacientes. Portanto, a transfusão de concentrado de hemácias em cães é eficaz para diminuição da hipóxia tecidual demonstrada pelo acompanhamento de parâmetros facilmente obtidos no exame físico.