A standard assessment tool for direct evaluation of procedural skills to ensure proficiency of trainees is necessary forcranial ultrasound (US) in clinical practice. This study created and validated an assessment tool for cranial US performanceby radiologists. An initial evaluation tool for cranial US using criteria was developed based on existing literature. The assessment form was modified using a three-round Delphi process by an expert panel, conducted betweenJanuary 2021 and April 2021. Rubric scales for grading were added once consensus regarding generated items was reached.Experts confirmed the final assessment tool using a rubric scale. Two raters evaluated cranial US performance of 27 residentsin video clips using the tool. Reliability and percent agreement were assessed. Seventeen pediatric radiologists working in different settings participated in the expert panel. The content validation of the proposed evaluation tool was enabledby expert pediatric radiologists. Following three rounds of the Delphi process, the initial 14-item assessment form became a final 15-item form. A three-part rubric scale was used in the final form (preparation, US machine operation, and cranial USperformance). Interrater reliability was evaluated with Cohen's Kappa. The Kappa value and percent interrater agreement for most items was moderate to almost perfect (0.42-0.93 and 77.8-100%, respectively). The Cronbach's alpha values for bothraters were 0.856 and 0.891. This study produced the first validated cranial US assessment tool using a modifiedDelphi method. The final assessment form is a simple and reliable tool.

PurposeTo compare the diagnostic performance of 18F-fluorodeoxyglucose (18F-FDG) and 18F-fluoroestradiol (18F-FES) positron emission tomography/computed tomography (PET/CT) for initial staging of estrogen receptor (ER) positive breast cancer.MethodsTwenty-eight patients with ER-positive breast cancer underwent 18F-FDG and 18F-FES PET/CT for initial staging. Diagnostic performance and concordance rates were analyzed for both radiotracers. Semiquantitative parameters of maximum standardized uptake value (SUVmax) and tumor-to-normal ratio (T/N ratio) were compared using Wilcoxon signed-rank test. Factors potentially affecting the degree of radiotracer uptake were analyzed by multi-level linear regression analysis.ResultsThe overall diagnostic performance of 18F-FES was comparable to 18F-FDG, except for higher specificity and NPV, with sensitivity, specificity, PPV, NPV, and accuracy of 87.56%, 100%, 100%, 35.14%, and 88.35%, respectively, for 18F-FES and 83.94%, 30.77%, 94.74%, 11.43%, and 95.37%, respectively, for 18F-FDG. Diagnostic performance of strong ER expression was better in 18F-FES but worse for 18F-FDG. There was a correlation of mucinous cell type and Allred score 7–8 with 18F-FES uptake, with correlation coefficients of 26.65 (19.28, 34.02), 5.90 (− 0.005, 11.81), and p-value of < 0.001, 0.05, respectively. Meanwhile, luminal B and Ki-67 were related to 18F-FDG uptake, with correlation coefficients of 2.76 (1.10, 0.20), 0.11 (0.01, 0.2), and p-value of 0.018, 0.025, respectively.ConclusionDiagnostic performance of 18F-FES is comparable to 18F-FDG, but better for strongly ER-positive breast cancer. Combination of 18F-FES and 18F-FDG would potentially overcome the limitations of each tracer with more accurate staging.

Increasing the availability of alternative protein from insects is important for solving food shortages. Not only are insects a rich source of protein, but using insect as ingredients could reduce food waste. Insects are thus a potentially valuable ingredient for food industries and even sustainable food. The three-dimensional production of food for future food has gained attention owing to its potential to reduce autonomous food production and produce sustainable food. This study investigated the printability and rheological properties of a high-protein food system derived from mealworms and guar gum used to improve printability. The stability and rheological properties were analyzed for various printing parameters. The results indicate that the yield stress of the mealworm paste dramatically increased (39 to 1096 Pa) with even a small guar gum concentration resulting in an increase (0 to 1.75%). Increasing the guar gum concentration thus resulted in a mealworm paste that had a more significant value of hardness and cohesiveness but reduced adhesiveness (p &lt; 0.05). In conclusion, the addition of guar gum increased viscosity, and caused the paste to exhibit a shear thinning behavior and ability to support itself and was thus more stable. In summary, introducing guar gum resulted in a mealworm paste with rheological properties more suitable for printing in terms of printability and stability.

This study aimed to extract aromatic compounds from the rhizomes, leaf sheaths, and leaves of Hedychium coronarium and investigate their chemical compositions, cosmetic/cosmeceutical activities, and irritation potency. The chemical compositions were investigated via gas chromatography-mass spectrometry. The antioxidant activities were evaluated via spectrophotometry. The anti-skin wrinkle properties were investigated via collagenase, elastase, and hyaluronidase inhibition. The irritation potency was observed via a hen's egg-chorioallantoic membrane test. Eucalyptol was detected as a major component in the rhizomes and leaf sheaths, while β-caryophyllene was predominant in the leaves. The absolutes from the rhizomes were the strongest antioxidants, with ABTS scavenging properties similar to L-ascorbic acid. Interestingly, the equivalent concentration (EC1) of the absolute from the rhizome was 0.82 ± 0.01 µg FeSO4/g extract, which was significantly more potent than L-ascorbic acid (0.43 ± 0.03 µg FeSO4/g extract). The rhizome-derived absolute was the most effective against collagenase, while the concretes from the rhizomes and leaf sheaths showed promising anti-hyaluronidase activity with inhibitions of 90.5 ± 1.6% and 87.4 ± 5.1%, respectively. The irritability of the aromatic extracts was not different from that of the vehicle control, proving their safety. Therefore, the Hedychium coronarium rhizome-derived absolute was an attractive and potent antioxidant with anti-collagenase activities, indicating its potential for use in anti-aging formulations.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is one of the most common enzymopathies in humans, present in approximately half a billion people worldwide. More than 230 clinically relevant G6PD mutations of different classes have been reported to date. We hereby describe a patient with chronic hemolysis who presents a substitution of arginine by glycine at position 219 in G6PD protein. The variant was never described in an original publication or characterized on a molecular level. In the present study, we provide structural and biochemical evidence for the molecular basis of its pathogenicity. When compared to the wild-type enzyme, the Arg219Gly mutation markedly reduces the catalytic activity by 50-fold while having a negligible effect on substrate binding affinity. The mutation preserves secondary protein structure, but greatly decreases stability at higher temperatures and to trypsin digestion. Size exclusion chromatography elution profiles show monomeric and dimeric forms for the mutant, but only the latter for the wild-type form, suggesting a critical role of arginine 219 in G6PD dimer formation. Our findings have implications in the development of small molecule activators, with the goal of rescuing the phenotype observed in this and possibly other related mutants.

Human trichinellosis is a parasitic infection caused by roundworms belonging to the genus Trichinella, especially Trichinella spiralis. Early and accurate clinical diagnoses of trichinellosis are required for efficacious prognosis and treatment. Current drug therapies are limited by antiparasitic resistance, poor absorption, and an inability to kill the encapsulating muscle-stage larvae. Therefore, reliable biomarkers and drug targets for novel diagnostic approaches and anthelmintic drugs are required. In this study, metabolite profiles of T. spiralis adult worms and muscle larvae were obtained using mass spectrometry-based metabolomics. In addition, metabolite-based biomarkers of T. spiralis excretory-secretory products and their related metabolic pathways were characterized. The metabolic profiling identified major, related metabolic pathways involving adenosine monophosphate (AMP)-dependent synthetase/ligase and glycolysis/gluconeogenesis in T. spiralis adult worms and muscle larvae, respectively. These pathways are potential drug targets for the treatment of the intestinal and muscular phases of infection. The metabolome of larva excretory-secretory products was characterized, with amino acid permease and carbohydrate kinase being identified as key metabolic pathways. Among six metabolites, decanoyl-l-carnitine and 2,3-dinor-6-keto prostaglandin F1α-d9 were identified as potential metabolite-based biomarkers that might be related to the host inflammatory processes. In summary, this study compared the relationships between the metabolic profiles of two T. spiralis growth stages. Importantly, the main metabolites and metabolic pathways identified may aid the development of novel clinical diagnostics and therapeutics for human trichinellosis and other related helminthic infections.

Familial hypercholesterolemia (FH) is currently underdiagnosed and undertreated. The establishment of a FH registry could facilitate a deeper understanding of this disease. We described the clinical characteristics of subjects with FH from the Thai FH Registry, compared our data with the regional and global data, and identified gaps in the care of these subjects. A multicenter, nationwide prospective FH registry was established in Thailand. Our data were compared with those of the European Atherosclerosis Society-FH Studies Collaboration. Multiple logistic regression analyses were performed for variables associated with lipid-lowering medication (LLM) use and the attainment of low-density lipoprotein-cholesterol (LDL-C) goal. The study includes 472 subjects with FH (mean age at FH diagnosis: 46±12 years, 61.4% women). A history of premature coronary artery disease was found in 12%. The percentage of LLM use in subjects with a Dutch Lipid Clinic Network score of ≥ 6 (probable or definite FH) in our registry (64%) was slightly lower than the regional data but higher than the global data. Among those who received statins, 25.2% and 6.4% achieved LDL-C levels of ＜100 mg/dL and ＜70 mg/dL, respectively. Women with FH were less likely to achieve LDL-C ＜70 mg/dL (adjusted odds ratio: 0.22, 95% confidence interval: 0.06-0.71, p=0.012). FH in Thailand was diagnosed late, and treatment was inadequate for the majority of subjects. Women with FH were less likely to achieve LDL-C goals. Our insights could potentially help raise awareness and narrow the gap in patient care.

A randomized controlled trial. The aim of this study is to compare the efficacy of allografts and bioactive glass-ceramic (BG) cages for anterior cervical discectomy and fusion (ACDF) in treating cervical degenerative disc disease. We conducted a single-center, randomized controlled trial between August 2017 and August 2022. Participants were randomized into two groups, and consecutive patients requiring ACDF were randomly assigned to receive either the allograft cage or the BG cage. The surgical outcomes measured included pain levels, neck disability, surgical details, and radiological assessments. Of the 45 assessed, 40 participants were included, with 18 in the allograft cage group and 22 in the BG cage group. By the 12-month follow-up, both groups exhibited significant improvements in pain levels and disability scores, with no notable intergroup differences. Over 85% of patients in both groups were satisfied with their outcomes. Radiological assessments revealed stability in the cervical spine with both cage types post intervention. Although both materials showed a trend toward increased subsidence over time, the difference between them was not statistically significant. Fusion rates were comparable between the groups at 12 months, with BG cage showing a slightly higher early fusion rate at 6 months. No significant differences were observed between the two groups in terms of complications. Both allograft and BG cages are effective in ACDF surgeries for cervical degenerative disc disease, with both contributing to substantial postoperative improvements. Differences in disc height, interspinous motion, and subsidence were not significant in the last follow-up, indicating both materials' suitability for clinical use. Future research with a larger cohort and longer follow-up is needed to confirm these preliminary findings.

To precisely determine the severity of COVID-19-related pneumonia, computed tomography (CT) is an imaging modality beneficial for patient monitoring and therapy planning. Thus, we aimed to develop a deep learning-based image segmentation model to automatically assess lung lesions related to COVID-19 infection and calculate the total severity score (TSS). The entire dataset consisted of 124 COVID-19 patients acquired from Chulabhorn Hospital, divided into 28 cases without lung lesions and 96 cases with lung lesions categorized severity by radiologists regarding TSS. The model used a 3D-UNet along with DenseNet and ResNet models that had already been trained to separate the lobes of the lungs and figure out the percentage of lung involvement due to COVID-19 infection. It also used the Dice similarity coefficient (DSC) to measure TSS. Our final model, consisting of 3D-UNet integrated with DenseNet169, achieved segmentation of lung lobes and lesions with the Dice similarity coefficients of 91.52% and 76.89%, respectively. The calculated TSS values were similar to those evaluated by radiologists, with an R2 of 0.842. The correlation between the ground-truth TSS and model prediction was greater than that of the radiologist, which was 0.890 and 0.709, respectively.

Title: Efficacy of Monoclonal antibody Tixagevimab/Cilgavimab for prevention of SARS-CoV-2 infection among cancer patients : Double blined Randomized placebo Controlled trail (ProvMAB trial) Introduction Immunocompromised patients, particularly those with a Hematological malignancies or Oncologic malignancies, are at higher risk of SARS-Cov-2 infection, severe outcomes and mortality. Tixagevimab/Cilgavimab is a monoclonal antibody combination which binds to the SARS-CoV-2 spike protein. The PROVENT phase III clinical trial reported that Tixagevimab/Cilgavimab prophylaxis significantly reduced the risk of COVID-19 infection in immunocompromised participants who had not been vaccinated prior to enrollment. However, it should be noted that this trial was conducted before the emergence of the Omicron variant. While the approved Tixagevimab/Cilgavimab combination has demonstrated the ability to decrease the rate of symptomatic SARS-CoV-2 infection in patients at higher risk of inadequate response to vaccination. However, Tixagevimab/Cilgavimab was tested in a few studies that included patients with hematologic malignancies and oncologic malignancies, even if this population has shown an increased risk of unfavorable outcomes following infection (with high rates of hospitalization, intensive care unit admission, and mortality) and poor significant immunization following vaccines. Method We performed a randomized clinical trial double blind study to evaluate the rate of SARS-CoV-2 infection following pre-exposure prophylaxis with Tixagevimab/Cilgavimab 150/150 mg versus placebo in Hematologic malignancies and Oncologic malignancies patients who were on active treatment with systemic chemotherapy within 6 months. These patients received at least three doses of vaccination before enrollment, and neutralizing antibody and anti-spike antibody levels were measured at day 0, day 30, day 90 and day 180 after enrollment. The study was started from September 7, 2022, until July 19,2023, with a follow-up period of 180 days for all cases. Result A total of 138 participants were recruited, with 68 patients in the intervention arm and 70 patients in the placebo arm. The mean age in the intervention arm was 58 years old, while it was 59 years old in the placebo arm. The cumulative incidence of Covid-19 infection was 7.4% in intervention arm compared to 7.15% in the placebo arm (HR= 1.04; 95% CI :0.3 to 3.58, p-value=0.956). Covid-19-related-hopitalizations were 5.9% of the intervention arm and 1.4% of the placebo arm. No patients need to admit ICU in both arms. No deaths due to Covid-19 infection were reported during the study. Discussion In this study, we present our findings comparing Tixagevimab/Cilgavimab in immunocompromised patients who received over three doses of vaccination for the prevention of SARS-CoV-2 infection in patients with hematologic malignancies and Oncologic malignancies undergoing chemotherapy during the SARS-CoV-2 omicron surge. Our results suggest that booster vaccinations, beyond the standard three doses, were sufficient to protect against SARS-CoV-2 infection in this particular patient population, considering their ongoing standard of care during the pandemic variant in the future. Keywords: SARS-CoV-2, COVID-19, Tixagevimab/Cilgavimab, Hematological malignances, monoclonal antibodies