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This case report discusses a diagnosis of uterine torsion in an 84-year-old woman who presented with five days of right lower quadrant abdominal pain, nausea, vomiting, constipation, and poor intake. Computed tomography (CT) imaging demonstrated a whorled configuration at the junction of the cervix and lower uterine segment, with the left gonadal vein crossing midline, and two previously known right leiomyomas now appearing on the left. These findings were consistent with the diagnosis of uterine torsion. She then underwent an urgent exploratory laparotomy, and the uterus was found to be dextroverted 270 degrees, with dark mottled purple tissue and engorged vessels. A supracervical hysterectomy and bilateral salpingo-oopherectomy were performed. Final pathology demonstrated extensive necrosis. This case reviews the classic presentation and imaging findings for the rare diagnosis of uterine torsion and options for management of both non-gravid and gravid patients.

Abstract Despite widespread cervical cancer (CC) screening programs, low participation has led to high morbidity and mortality rates, especially in developing countries. Because early-stage CC often has no symptoms, a non-invasive and convenient diagnostic method is needed to improve disease detection. In this study, we developed a new approach for differentiating both CC and cervical intraepithelial neoplasia (CIN)2/3, a precancerous lesion, from healthy individuals by exploring CC fatty acid metabolic reprogramming. Analysis of public datasets suggested that various fatty acid metabolizing enzymes were expressed at higher levels in CC tissues than in normal tissues. Correspondingly, 11 free fatty acids (FFAs) showed significantly different serum levels in CC patient samples compared with healthy donor samples. Nine of these 11 FFAs also displayed significant alterations in CIN2/3 patients. We then generated diagnostic models using combinations of these FFAs, with the optimal model including stearic and dihomo-γ-linolenic acids. Receiver operating characteristic curve analyses suggested that this diagnostic model could detect CC and CIN2/3 more accurately than using serum squamous cell carcinoma antigen level. In addition, the diagnostic model using FFAs was able to detect patients regardless of clinical stage or histological type. Overall, the serum FFA diagnostic model developed in this study could be a powerful new tool for the non-invasive early detection of CC and CIN2/3.

Background: Policies and strategies for handling stunting cases effectively and efficiently vary in different regions, depending on their situation and conditions. There has yet to be an empirical study of stunting management with a holistic-comprehensive and integrated approach in Indonesia, especially in Buleleng Regency, Bali. Thus, conducting initial research to analyze the policy and determine the right stunting management strategy to implement is essential. Purpose: This study aims to map stunting cases, explore their causal factors, analyze the suitable policy model for overcoming stunting and describe the effective and efficient stunting management strategy in Buleleng Regency based on a holistic, comprehensive, and integrated approach. Methods: This is a situation analysis case study. Respondents were stunted children and related governmental agencies in Buleleng Regency, Bali. The incidence of stunting, risk factors suspected as the cause, policy models and appropriate stunting handling strategies were analyzed in depth using qualitative and quantitative methods. Results: There were 1040 cases of stunting in the regency, with the highest cases in Banjar District. Significant risk factors influencing the stunting incidence in the region include the lack of good complementary feeding (OR: 2.6722; p

The role of the gut microbiota in the gut-brain axis has attracted attention in recent years. Some gut microbiota produces γ-aminobutyric acid (GABA), a major inhibitory neurotransmitter in mammals, in vitro, but the correlation between gut microbiota composition and intestinal GABA concentration, as well as the action of intestinal GABA in vivo, are poorly understood. Herein, we found that the intestinal GABA concentration was increased in mice by the intervention of the gut microbiota with neomycin or Bifidobacterium bifidum TMC3115 (TMC3115). Administration of TMC3115 reduced anxiety without affecting serum levels of serotonin, corticosterone, or GABA. We further found that intestinal epithelial cells expressed GABA receptor subunits and mediated mitogen-activated protein kinase signaling upon GABA stimulation. In addition, administration of TMC3115 induced mitogen-activated protein kinase signaling in colonic epithelial cells but not in small intestinal epithelial cells in mice. These results indicate that GABA produced by the gut microbiota, mainly in the colon, may affect host behavioral characteristics via GABA receptors expressed in intestinal epithelial cells without being transferred to the blood. This study suggests a novel mechanism by which intestinal GABA exerts physiological effects, even in the presence of the blood-brain barrier.

Background: Computed tomography (CT) is the gold standard for diagnosing canine nasal diseases. However, it cannot easily detect minor abnormalities in inflammatory diseases because they are not accompanied by obvious morphological changes. Aim: The present study aimed to compare the differences in normal CT findings of turbinate structure and mucosa between breeds in order to establish criteria for CT diagnosis of inflammatory diseases of the nasal cavity. Methods: CT data from 77 dogs of five breeds without nasal diseases were retrospectively studied. The nasal air percentage, which reflects the volume of the nasal turbinate structure and mucosa, was measured. The nasal turbinate mucosa was measured for contrast enhancement reflecting blood flow. Measurements were performed in the ventral and ethmoid turbinate regions. Comparisons were made between breeds and sections. Results: The air percentage in the ventral and ethmoid turbinate regions was significantly different between breeds. Contrast enhancement was significantly different between breeds only in the ethmoid turbinate. Moreover, different breeds had different correlations between body weight, age, nose length, and air percentage. Conclusion: In this study, reference values for normal CT findings of the nasal structure and mucosa were obtained, taking into account the breed, measurement section, and patient factors. The results showed that the volume of the turbinate structure and contrast enhancement of nasal mucosa differed depending on the breed. The measured values also differed depending on the cross-sections and patient factors. [Open Vet J 2024; 14(5.000): 1182-1190]

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has changed our lifestyle by imposing restrictions, such as physical distancing. The effect of COVID-19 prevalence on seasonal variations in glycemic control in patients with diabetes mellitus (DM) remains unknown. Methods This single-center retrospective cohort study evaluated glycemic control in patients with type 2 DM who visited Sugi Cardiovascular Hospital in December 2021. We evaluated the clinical findings of all patients treated regularly between March 1, 2019, and December 31, 2021, including the periods both before and after the COVID-19 pandemic. All the standard treatments were approved. Furthermore, seasonal changes in hemoglobin A1c (HbA1c) levels were evaluated using stratified analyses based on age. Results This study analyzed 86 patients (mean age, 69.6 ± 9.2 years; men, 57). Median HbA1c (National Glycohemoglobin Standardization Program [Union of Clinical Chemistry]) levels in spring (March) were 7.70% (interquartile range (IQR):7.23%–8.30%) [60.6 mmol/mol (IQR:55.4–67.2 mmol/mol)], 7.35% (IQR:6.90%–7.90%) [56.8 mmol/mol (IQR:51.9–62.8 mmol/mol)], and 7.50% (IQR:7.10%–8.00%) [58.5 mmol/mol (IQR:54.1–63.9 mmol/mol)] in 2019, 2020, and 2021, respectively. During these periods, HbA1c levels and body mass index (BMI) revealed significant seasonal variations “high in spring” and “low in autumn.” Median HbA1c levels in spring (March) and autumn (September) were 7.86% [61.2 mmol/mol] and 7.48% [57.4 mmol/mol] in 2019 (P

Background: Radiographic examination of the middle ear in French bulldogs can be challenging due to their small ear cavity and thick walls. Quantifying opacity on radiographic images is required to determine normal or abnormal results. Aim: To quantify the radiographic opacity of the middle ear in French bulldogs and create a threshold for objective diagnosis. Methods: A study was conducted on 32 French Bulldogs using radiographic images. Significant difference tests were performed on the ears of patients with unilateral and bilateral middle ear filling on computed tomography. A threshold was established for detecting left-right asymmetry in the same individuals. Additionally, comparisons were made between the filling and non-filling middle ear groups to establish a threshold of pixel values that could determine single middle ear filling and nonfilling for different patient images. Results: Significant differences were observed in the left-right difference in max, left-right difference in max-ave, and left–right ratio of max-ave between unilateral and bilateral filling groups. The max-ave left-right ratio had the highest AUC value with a cutoff of 1.077 and 92.3% sensitivity. The item that showed a significant difference between middle ear groups with and without filling was corrected for nasopharyngeal pixel values with a cutoff of 1.028 and 85% sensitivity. Conclusion: Pixel value ratios in the middle ear region can detect asymmetries in ear densities. The max value in the region compared to the same image's nasopharyngeal region can determine the filling. Combining individual ear evaluations and symmetry improves accuracy. [Open Vet J 2024; 14(3.000): 895-901]

Abstract Cough is known as a protective reflex to keep the airway free from harmful substances. Although brain activity during cough was previously examined mainly by functional magnetic resonance imaging (fMRI) with model analysis, this method does not capture real brain activity during cough. To obtain accurate measurements of brain activity during cough, we conducted whole-brain scans during different coughing tasks while correcting for head motion using a restraint-free positron emission tomography (PET) system. Twenty-four healthy right-handed males underwent multiple PET scans with [15O]H2O. Four tasks were performed during scans: “resting”; “voluntary cough (VC)”, which simply repeated spontaneous coughing; “induced cough (IC)”, where participants coughed in response to an acid stimulus in the cough‐inducing method with tartaric acid (CiTA); and “suppressed cough (SC)”, where coughing was suppressed against CiTA. The whole brain analyses of motion-corrected data revealed that VC chiefly activated the cerebellum extending to pons. In contrast, CiTA-related tasks (IC and SC) activated the higher sensory regions of the cerebral cortex and associated brain regions. The present results suggest that brain activity during simple cough is controlled chiefly by infratentorial areas, whereas manipulating cough predominantly requires the higher sensory brain regions to allow top-down control of information from the periphery.

Salafi community in Ambon have developed since the arrival of Laskar Jihad during the 1999 Ambon Conflict. Social dan religious competition has divided them, which is not only triggered by their interpretation of Islam but also by their efforts to gain religious influence and socio-religious dominance within the Islamic society. The research method used in this research is qualitative phenomenology. The research results found that for the Salafis, love for their homeland was proven during the COVID-19 pandemic; Salafi groups in Ambon also implement all policies issued by the Indonesian government without exception. Religious moderation is a fair and balanced attitude that does not exaggerate or belittle religion. Another characteristic of the moderation attitude shown is constantly repairing and avoiding damage. Salafi community in Ambon continue try to protect their faith, soul, reason, honor, lineage, and property. They respect fellow religious people, regardless their religious background and beliefs.

Background: Burn injuries are an alarming indicator of the sensitivity of human tissue when confronted with high temperatures or chemicals. The current treatment for burn wounds needs to be improved and more extensive in scope. Significant research advances concerning the therapeutic potential of secretomes over the past two decades have expanded the range of therapies that utilize secretomes to encompass populations other than stem cells. Aim: This study details how the secretome extracted from the Bovine Umbilical Vein Endothelial Cell (BUVEC) promotes the healing of burn injuries. Methods: The 48 rats were divided into four groups, namely the control group with povidone-iodine, the 5% BUVEC-CM cream group, the 10% BUVEC-CM cream group, the 15% BUVEC-CM cream group. Animals induced type II burns under anesthesia. Treatment is carried out topically, 2 times a day. Every day the wound was measured. The animals were put to sleep for samples on days 5, 13, 21, and 19. Samples in the form of skins were soaked in 4% paraformaldehyde and processed with paraffin-embedded for tissue preparations. The research results were processed using Two Ways ANOVA. Results: The study showed that on day 5, wound closure occurred, whereas in the povidone-iodine group, macroscopically, the wound closed faster. Epithelial repair, increased fibroblasts and collagen, and blood vessel formation greatly increased in the 15% BUVEC-CM group on days 13, 21, and 29. Conclusion: Taken together, BUVEC secretome promoted fibroblast regeneration, collagen formation, re-epithelialization, and hair follicle regeneration on the burn injury wound healing. [Open Vet J 2023; 13(12.000): 1597-1606]

The emerging of formal mathematical proof is an essential component in advanced undergraduate mathematics courses. Several colleges have transformed mathematics courses by facilitating undergraduate students to understand formal mathematical language and axiomatic structure. Nevertheless, college students face difficulties when they transition to proof construction in mathematics courses. Therefore, this descriptive-explorative study explores prospective teachers' mathematical proof in the second semester of their studies. There were 240 pre-service mathematics teachers at a state university in Surabaya, Indonesia, determined using the conventional method. Their responses were analyzed using a combination of Miyazaki and Moore methods. This method classified reasoning types (i.e., deductive and inductive) and types of difficulties experienced during the proving. The results conveyed that 62.5% of prospective teachers tended to prefer deductive reasoning, while the rest used inductive reasoning. Only 15.83% of the responses were identified as correct answers, while the other answers included errors on a proof construction. Another result portrayed that most prospective teachers (27.5%) experienced difficulties in using definitions for constructing proofs. This study suggested that the analytical framework of the Miyazaki-Moore method can be employed as a tool to help teachers identify students' proof reasoning types and difficulties in constructing the mathematical proof.

The present study was conducted to compare the effectiveness of Geometer's Sketchpad (GSP) learning in two-dimensional shapes. This study was designed as a quasi-experiment which involved 60 students of class VII in SMP Negeri 1 Ngoro, Mojokerto, Indonesia. The sample in study was divided into two groups, mainly 30 students are the experiment class (GSP) and 30 students are the control class (conventional learning). There were three instruments used in this study namely, students' responses, and pretest-posttests. The data were analyzed using analysis of covariance (ANCOVA). T-test showed that the effectiveness of student learning outcomes in GSP learning is higher than those in conventional learning. Based on the results of the student learning outcomes indicated that students in the experimental group outperformed those in the control group. In addition, a survey instrument was used to elicit students' perception on the use of GSP. Analysis of the questionnaire responses indicated a positive overall perception of using GSP in learning about two-dimensional shapes. Thus, it can be concluded that GSP learning was effective in two dimensional-shapes learning.

Toxoplasma, an important intracellular parasite of humans and animals, causes life-threatening toxoplasmosis in immunocompromised individuals. Although Toxoplasma secretory proteins during acute infection (tachyzoite, which divides rapidly and causes inflammation) have been extensively characterized, those involved in chronic infection (bradyzoite, which divides slowly and is surrounded by a cyst wall) remain uncertain. Regulation of the cyst wall is essential to the parasite life cycle, and polysaccharides, such as chitin, in the cyst wall are necessary to sustain latent infection. Toxoplasma secretory proteins during the bradyzoite stage may have important roles in regulating the cyst wall via polysaccharides. Here, we focused on characterizing the hypothetical T. gondii chitinase, chitinase-like protein 1 (TgCLP1). We found that the chitinase-like domain containing TgCLP1 is partially present in the bradyzoite microneme and confirmed, albeit partially, its previous identification in the tachyzoite microneme. Furthermore, although parasites lacking TgCLP1 could convert from tachyzoites to bradyzoites and make an intact cyst wall, they failed to convert from bradyzoites to tachyzoites, indicating that TgCLP1 is necessary for bradyzoite reactivation. Taken together, our findings deepen our understanding of the molecular basis of recrudescence and could contribute to the development of novel strategies for the control of toxoplasmosis.

Abstract Aim To investigate the risk factors for postoperative delirium among elderly patients undergoing elective surgery for gastroenterological cancer. Methods From May 2020 to March 2022, patients ≥75 years old with gastroenterological cancer who underwent radical surgery were enrolled. The geriatric assessment, including evaluations of frailty, physical function, nutrition status, and cognitive function, was conducted preoperatively. The confusion assessment method was used to diagnose postoperative delirium. A multivariate logistic regression analysis was used to determine risk factors for postoperative delirium. Results A total of 158 patients were eligible for inclusion in this study. Of these 53 patients (34%) developed postoperative delirium. In the univariate analysis, the age, regular use of sleeping drugs and benzodiazepine, Charlson Comorbidity Index score, performance status, Fried's frailty score, Vulnerable Elders Survey‐13 score, grip weakness, Short Physical Performance Battery (SPPB) score, Mini Nutritional Assessment Short‐Form score, and Mini‐Mental State Examination score were statistically associated with the incidence of postoperative delirium. In the multivariate analysis, a SPPB score ≤9, Mini Nutritional Assessment score ≤11, a Mini‐Mental State Examination score ≤24, and regular use of benzodiazepine were found to be independent preoperative risk factors for postoperative delirium. Conclusion Certain findings during the preoperative geriatric assessment, especially low SPPB, Mini Nutritional Assessment Short‐Form and Mini‐Mental State Examination scores, and regular use of benzodiazepine were risk factors for postoperative delirium in elderly patients undergoing gastroenterological surgery.

Background: Peristalsis-related streak artifacts on the liver compromise image quality and diagnostic accuracy. Purpose: To assess dual-layer spectral-detector computed tomography (CT) image reconstructions for reducing intestinal peristalsis-related streak artifacts on the liver. Methods: We retrospectively evaluated 220 contrast-enhanced abdominal dual-energy CT scans in 131 consecutive patients (mean age: 68 ± 10 years, 120 men) who underwent routine clinical dual-layer spectral-detector CT imaging (120 kVp, 40 keV, 200 keV, virtual non-contrast (VNC), iodine images). Two independent readers evaluated bowel peristalsis streak artifacts on the liver qualitatively on a five-point Likert scale (1 = none to 5 = severe) and quantitatively by depth of streak artifact extension into the liver and measurements of Hounsfield Unit and iodine concentration differences from normal liver. Artifact severity between image reconstructions were compared by Wilcoxon signed-rank and paired t-tests. Results: 12 scans were excluded due to missing spectral data, artifacts on the liver originating from metallic foreign materials, or oral contrast material. Streak artifacts on the liver were seen in 51/208 (25%) scans and involved the left lobe only in 49/51 (96%), the right lobe only in 0/51 (0%), and both lobes in 2/51 (4%) scans. Artifact frequency was lower in iodine than in 120 kVp images (scans 18/208 vs. 51/208, p < 0.001). Artifact severity was less in iodine than in 120 kVp images (median score 1 vs. 3, p < 0.001). Streak artifact extension into the liver was shorter in iodine than 120 kVp images (mean length 2 ± 4 vs. 12 ± 5 mm, p < 0.001). Hounsfield Unit and iodine concentration differed significantly between bright streak artifacts and normal liver in 120 kVp, 40 keV, 200 keV, and VNC images (p < 0.001, each), but not in iodine images (p = 0.23). Conclusion: Intestinal peristalsis-related streak artifacts commonly affect the left liver lobe at CT and can be substantially reduced by viewing iodine dual-energy CT image reconstructions.

Purpose: To assess the influence of different dual-energy CT (DECT) scanner techniques on the severity of visceral-motion-related artifacts on the liver. Methods: Two independent readers retrospectively evaluated visceral-motion-related artifacts on the liver on 120-kVp(-like), monoenergetic low- and high-keV, virtual non-contrast (VNC), and iodine images acquired on a dual-source, twin-beam, fast kV-switching, and dual-layer spectral detector scanner. Quantitative assessment: Depth of artifact extension into the liver, measurements of Hounsfield Units (HU) and iodine concentrations. Qualitative assessment: Five-point Likert scale (1 = none to 5 = severe). Artifact severity between image reconstructions were compared by Wilcoxon signed-rank and paired t-tests. Results: 615 contrast-enhanced routine clinical DECT scans of the abdomen were evaluated in 458 consecutive patients (mean age: 61 ± 14 years, 331 men). For dual-source and twin-beam scanners, depth of extension of artifacts into the liver was significantly shorter and artifact severity scores significantly lower for 120-kVp-like images compared with the other image reconstructions (p < 0.001, each). For fast kV-switching and spectral detector scanner images, depth of extension of artifacts was significantly shorter and artifact severity scores significantly lower for iodine images (p < 0.001, each). Dual-source 120-kVp-like and spectral detector iodine images reduced artifacts to an extent that no significant difference in HU or iodine concentrations between artifacts (dual-source: 97 HU, spectral detector: 1.9 mg/mL) and unaffected liver parenchyma (dual-source: 108 HU, spectral detector: 2.1 mg/mL) was measurable (dual-source: p = 0.32, spectral detector: p = 0.15). Conclusion: Visceral-motion-related artifacts on the liver can be markedly reduced by viewing 120-kVp-like images for dual-source and twin-beam DECT scanners and iodine images for fast kV-switching and dual-layer spectral detector DECT scanners.

Traditional teaching methods in radiology education have not kept pace with advances in technology that foster successful transition into independent practice. This deficit has been exacerbated by the COVID-19 pandemic, as the need for social distancing and the introduction of hybrid staffing models have decreased the critical educational interactions at the reading room workstations between staff and trainees. By leveraging interactive, case-based learning, educators have the opportunity to bridge the substantial gap between basic pattern recognition and successfully making a diagnosis in independent practice. For the educator, this signals a shift away from perfect case selection and presenter authority, and toward the role of a guide facilitating an active case-based learning experience. This form of learning is best accompanied by guided interpretation and iterative feedback with the goal of developing similar levels of mastery and autonomy among graduating trainees. In this article, we present the tools and methods for incorporating interactive cases into existing and novel teaching materials to meet the unique challenges educators are facing today.

Background: Neurodegenerative diseases are characterized by damage to the central nervous system through the progressive decrease in the structure and function of neurons, followed by neuronal death. Current therapy for these diseases is still limited. Bovine umbilical vein endothelial cells conditioned medium (BUVEC-CM) is a medium harvested from culture of bovine umbilical vein endothelial cells (BUVEC). This study aimed to evaluate the capability of BUVEC-CM to prevent neurotoxicity induced by trimethyltin (TMT) on human neuroblastoma SH-SY5Y cells. Methods: The tests carried out were a viability test with MTT and CCK-8 assay, scratch wound assay to determine cell migration, Hoechst 33342 and AO/PI staining to detect apoptosis, ELISA test to measure the concentration of BDNF, and RT-qPCR to determine the expression of CD68, caspase-7 and caspase-9, and DCFH-DA staining to detect reactive oxygen species (ROS). Results: BUVEC-CM maintained the viability of cells, increase cell migration, prevent cell apoptosis, increase BDNF levels, decrease the expression of CD68, as well as the caspase-7 and -9 genes, and suppress ROS generation. Conclusions: BUVEC-CM can protect from neurodegeneration in SH-SY5Y cells through upregulation of BDNF and downregulation of CD68, caspase-7 and caspase-9.