Comprehensive Laboratory Evaluation Research Articles

Induction Radiochemotherapy for Esophageal Cancer: Long-Term Outcomes from a Single-Center Study.

Background/Objectives: The management of esophageal cancer (EC) remains a significant clinical challenge, particularly in optimizing therapeutic strategies for different stages and subgroups. This study assessed the impact of preoperative radiochemotherapy (CRT) on clinical staging and identified subgroups for whom definitive CRT (dCRT) may provide a favorable alternative to surgery. Methods: Sixty-one patients with esophageal adenocarcinoma or squamous cell carcinoma were enrolled. Pre-treatment staging included computed tomography, gastroscopy with biopsy, and comprehensive laboratory evaluations. Patients received preoperative CRT following the CROSS or dCRT protocols based on tumor stage. Surgical approaches included staged esophagectomy or single-stage Ivor Lewis procedures. Four patients declined surgery and were treated with dCRT. Postoperative outcomes were evaluated using pTNM classification. Follow-up included imaging and endoscopic surveillance. Statistical analyses assessed changes in staging and factors influencing treatment outcomes. Results: CRT significantly reduced T stage across the entire cohort (p = 0.0002), with complete pathological response (pT0N0M0) observed in 54.5% of patients following induction CRT (p = 0.0001). Male patients demonstrated a significant reduction in T stage (p = 0.0008), while a similar trend in females was not significant (p = 0.068). Among patients declining surgery, dCRT demonstrated acceptable oncologic control over a mean follow-up of 4 ± 0.79 years. Conclusions: Preoperative CRT effectively downstages EC and achieves high rates of response, especially in male patients. Therefore, dCRT may be a viable alternative in selected patients, emphasizing the need for individualized treatment strategies to optimize outcomes. These findings underscore the importance of refining multimodal approaches in EC care.

Liver Fibrosis Index-4 Does Not Correlate to Liver Elastography in Patients with Inflammatory Bowel Disease.

Background: Inflammatory bowel disease (IBD) is associated with an increased prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD). The Fibrosis-4 (FIB-4) index is a non-invasive tool for assessing liver fibrosis that has been validated in various liver diseases. The main objective of this study was to study whether the FIB-4 index is a reliable predictor of liver fibrosis, as assessed through elastography, in patients with IBD. We additionally aimed to analyze if FIB-4 associates with IBD characteristics such as lipid profile, subclinical carotid atherosclerosis, and insulin resistance indices. Methods: A cross-sectional study was conducted, enrolling 197 patients with IBD. Subjects underwent comprehensive clinical and laboratory evaluations. Hepatic fibrosis was assessed non-invasively using the FIB-4 index and transient elastography, while abdominal ultrasonography was performed to grade hepatic steatosis based on the degree of fat infiltration. To investigate the associations between disease characteristics and FIB-4 score and the correlation of this index to elastography, a multivariable linear regression analysis was conducted. Results: The presence of diabetes, hypertension, and metabolic syndrome was associated with significantly higher FIB-4 levels. However, FIB-4 did not show a relationship with disease characteristics such as phenotype or activity indices. Furthermore, FIB-4 did not demonstrate a correlation with liver stiffness values measured by elastography. Conclusions: Our findings suggest that the FIB-4 index may not be a reliable tool for assessing hepatic fibrosis in patients with IBD. This observation is particularly significant given the high prevalence of MASLD in the IBD population.

Late Hepatocellular Carcinoma Occurrence in Patients Achieving Sustained Virological Response After Direct-Acting Antiviral Therapy: A Matter of Follow-Up or Something Else?

Background: Despite achieving a sustained virological response (SVR) with direct-acting antivirals (DAAs), an unexpected increase in the occurrence rate of hepatocellular carcinoma (HCC) has been observed among HCV-treated patients. This study aims to assess the long-term follow-up of HCV patients treated with DAAs who achieved an SVR to investigate the potential for late-onset HCC. Methods: In this prospective multicenter study, we enrolled consecutive HCV patients treated with DAAs following Italian ministerial guidelines between 2015 and 2018. Exclusion criteria included active HCC on imaging, prior HCC treatment, HBV or HIV co-infection, or liver transplant recipients. Monthly follow-ups occurred during treatment, with subsequent assessments every 3 months for at least 48 months. Abdominal ultrasound (US) was performed within two weeks before starting antiviral therapy, supplemented by contrast-enhanced ultrasonography (CEUS), dynamic computed tomography (CT), or magnetic resonance imaging (MRI) to evaluate incidental liver lesions. Results: Of the 306 patients completing the 48-months follow-up post-treatment (median age 67 years, 55% male), all achieved an SVR. A sofosbuvir-based regimen was administered to 72.5% of patients, while 20% received ribavirin. During follow-up, late-onset HCC developed in 20 patients (cumulative incidence rate of 6.55%). The pattern of HCC occurrence varied (median diameter 24 mm). Multivariate and univariate analyses identified liver stiffness, diabetes, body mass index, and platelet levels before antiviral therapy as associated factors for late HCC occurrence. Conclusions: Our findings suggest that late HCC occurrence may persist despite achieving SVR. Therefore, comprehensive long-term follow-up, including clinical, laboratory, and expert ultrasonography evaluations, is crucial for all HCV patients treated with DAAs.

Impact of donor expanded criteria kidney transplantation on clinical outcomes and survival: A single-center experience

IntroductionThe scarcity of suitable donor organs has led to the inclusion of Expanded Criteria Donor (ECD) kidneys to augment the donor pool, despite potential concerns regarding post-transplant outcomes. MethodsThis retrospective study analyzed the clinical outcomes of a cohort of 317 kidney transplant recipients from deceased donors at a single center between 2008 and 2018. Patients were categorized into ECD and Standard Criteria Donor (SCD) groups, with primary nonfunctioning grafts excluded. Comprehensive laboratory evaluations were conducted, including HLA typing and serum creatinine levels. Immunosuppressive regimens were standardized, and statistical analyses were performed using the SPSS program. ResultsThe sample consisted of 83 (26.18%) patients who received kidney transplants from ECDs and 234 (73.82%) from SCDs. The ECD group showed a longer cold ischemia time (p = 0.019) and a higher rate of delayed graft function (DGF) compared with the SCD group. No significant differences were observed in graft survival (p = 0.370) or patient survival (p = 0.993) between the ECD and SCD groups. However, differences in graft survival were noted between the groups when stratified by DGF status: ECD with DGF vs. ECD without DGF (p = 0.029), ECD with DGF vs. SCD with DGF (p = 0.188), ECD with DGF vs. SCD without DGF (p = 0.022), ECD without DGF vs. SCD with DGF (p = 0.014), ECD without DGF vs. SCD without DGF (p = 0.340), and SCD with DGF vs. SCD without DGF (p = 0.195). No differences in patient survival rates were observed among these groups for all pairwise comparisons (p > 0.05) when stratified by donor criteria and DGF status. ConclusionsGraft and patient survival rates were comparable between ECD and SCD kidney transplant recipients.

The utility of pentraxin 3 and platelet-derived growth factor receptor beta as non-invasive biomarkers for prediction of cardiovascular risk in MAFLD patients

BackgroundMetabolic-associated fatty liver disease (MAFLD) has emerged as the predominant form of chronic liver disease globally linked with heightened cardiovascular disease (CVD) risk, the leading cause of mortality among affected individuals.AimThis study aims to assess serum PTX3 (pentraxin 3) and platelet-derived growth factor receptor beta (PDGFRβ) as potential non-invasive biomarkers for predicting cardiovascular risk (CVR) in MAFLD patients.MethodA case–control investigation encompassing 84 MAFLD patients without prior CVD history and 30 age- and gender-matched healthy controls was conducted. Both cohorts underwent comprehensive laboratory and radiological evaluations. CVR was evaluated through common carotid artery intima-media thickness (IMT), Framingham risk score, and QRISK 2 score. The efficacy of two ELISA biomarkers PTX3 and PDGFRβ was examined for correlation with CVR in MAFLD patients.ResultsMAFLD patients displayed significantly heightened levels of PTX3 and PDGFβ compared to healthy controls (P < 0.001, P = 0.016, respectively). PDGFβ exhibited a notably positive correlation with the Framingham score (P = 0.016), while no significant correlation was observed with pentraxin 3 (P = 0.061). Univariate and multivariate analyses identified diabetes mellitus (DM) (P < 0.001*), hypertension (P = 0.005), visceral fat (P < 0.001*), waist/hip circumference (P = 0.04), and PDGFβ (P = 0.03) as robust predictors of CVR, with PTX3 demonstrating limited prognostic utility.ConclusionPDGFβ emerged as a promising early non-invasive predictor of CVR in MAFLD patients, highlighting its potential role in guiding tailored preventive interventions, while PTX3 exhibited a modest impact warranting further investigation.

The use of the WHO criteria to detect severe malaria among patients clinically diagnosed with uncomplicated malaria.

The World Health Organization (WHO) strict defining criteria were used to identify severe malaria among Ghanaian patients clinically diagnosed as uncomplicated malaria. From each study participant, blood haemoglobin (Hb) and plasma bilirubin levels were estimated using automated analyzers. According to the WHO, the criteria for diagnosing severe malaria among children (< 12 years) was assessed using Hb < 5 g/dL and among other patients ≥ 12 years, Hb < 7 g/dL with parasitemia > 10,000/μL, plasma bilirubin > 50 μmol/L amidst parasitemia > 100,000/μL and P. falciparum hyperparasitaemia (> 500,000 parasites/μL). Patients initially diagnosed with asymptomatic malaria (n = 347) were recruited. The parasitemia range was 540-863,402 parasite/μL. Overall, 86.2% of the patients had uncomplicated malaria while 13.8% of the patients were diagnosed with severe malaria of various origins. In children < 12 years, 10.8% (17/157) had Hb < 5g/dL with parasitaemia < 10,000 parasites/μL and in other patients (≥ 12 years), 6.3% (12/190) of them recorded Hb < 7g/dL with parasitaemia < 10,000 parasites/μL. Furthermore, 13.8% (48/347) had serum bilirubin levels > 50 μmol/L with parasitemia > 100,000/μL. In all the patients with hyperbilirubinemia, Hb levels fell below either 5g/dL or 7g/dL, for patients less than and 12 years or more, respectively. Finally, 1.7% (6/347) of the patients with malaria had parasite counts (> 500,000 parasites/μL). Irrespective of the etiology, patients diagnosed with severe malaria presented with pallor, vomiting, diarrhea, chills, fever and nausea, concurrently. Without comprehensive laboratory evaluation, patients with severe malaria could be misdiagnosed. Therefore, healthcare facilities need adequate human and logistical resources to be able to diagnose severe malaria for appropriate management to avert any untoward outcomes.

O-258 Clinical factors associated with sperm retrieval success in hypogonadal nonobstructive azoospermic males undergoing microdissection testicular sperm extraction

Abstract Study question What factors are associated with sperm retrieval (SR) success through microdissection testicular sperm extraction (micro-TESE) in nonobstructive azoospermic (NOA) males with biochemical hypogonadism? Summary answer The SR success in hypogonadal NOA males is associated with FSH levels, pre-micro-TESE hormonal stimulation, presence of clinical varicocele, varicocelectomy history, and testicular histopathology results. What is known already Previous studies have investigated clinical predictors for SR success in NOA males, such as testicular volume, genetic status, and testicular histopathology, but these factors cannot be modified before SR. On the other hand, pre-SR hormonal stimulation and varicocele repair have shown potential for improving SR rates, although the evidence is inconclusive due to heterogeneity in patients and treatments. This lack of information makes it difficult for clinicians to determine whether medical or surgical interventions should be used before SR in NOA patients. Study design, size, duration This observational cohort study involved 616 hypogonadal NOA patients with primary spermatogenic failure who underwent micro-TESE at a University-affiliated center for male reproductive health between 2014 and 2021. Biochemical hypogonadism was defined as total testosterone (T) levels &amp;lt;350 ng/dL, measured from morning venous samples. All patients were naïve concerning previous SR attempts and were categorized into two groups based on whether they received pre-SR hormonal stimulation with recombinant gonadotropins (hCG alone or combined with FSH). Participants/materials, setting, methods Patients aged 23-55 underwent comprehensive clinical, laboratory, and histopathological evaluations for NOA. Multivariable logistic regression analysis explored the associations between patient variables and micro-TESE success. Adjusted risk ratio (aRR) assessed the relationship between SR success and relevant predictors. SR rates were compared between patients receiving hormonal stimulation and those who did not. Logistic regression analysis evaluated the effect of baseline FSH levels, stratified by normogonadotropic (&amp;lt;12 IU/L) and hypergonadotropic (≥12 IU/L) classes, on SR success. Main results and the role of chance The overall micro-TESE success rate was 56.6%. Independent predictors of SR success included baseline FSH levels (aRR 0.98, 95% CI 0.96-0.99, p = 0.04), pre-SR hormonal stimulation (aRR 1.52, 1.28-1.73, p = 0.0002), the presence of clinical varicocele (aRR 0.09, 0.01-0.66, p = 0.04), history of previous varicocelectomy (aRR 1.53, 1.14-1.84, p = 0.01), and testicular histopathology results (p &amp;lt; 0.05). Patients who received hormonal stimulation achieved higher SR success rates than untreated patients (62.5% [182/291] vs. 51.4% [167/325], p = 0.006; aRR 1.52, 95% CI 1.28-1.73). Among patients receiving hCG-based hormonal stimulation, pre-micro-TESE T levels and Delta T (absolute increase in T levels from baseline) were associated with SR success (p &amp;lt; 0.0001). A pre-micro-TESE T level of 418.5 ng/dL (AUC: 0.78) and a Delta T of 258 ng/dL (AUC: 0.76) distinguished treated patients with positive and negative SR outcomes. Subgroup analysis by baseline FSH levels showed that normogonadotropic individuals (aRR 1.41, 1.16-1.58, p = 0.002) benefited from hormonal stimulation, whereas hypergonadotropic subjects did not (aRR 1.20, 0.86-1.50, p = 0.23). The frequency of patients showing biochemical hypogonadism after hCG stimulation was reduced to 22.3% (65/291). The micro-TESE postoperative complication rate was 2.3% (14/616), while the frequency of patients exhibiting adverse effects presumably attributed to hormonal stimulation was 10.3% (30/291). Limitations, reasons for caution Limitations of the study include its observational nature and the absence of pregnancy data. The study focused on micro-TESE as the SR method and hormonal stimulation solely based on hCG (as monotherapy or associated with FSH), so results may differ with other treatments. Wider implications of the findings Our study underscores the complexity of counseling hypogonadal men with NOA, stressing the significance of assessing various factors. While our findings suggest potential benefits from pre-SR interventions, particularly hormonal stimulation and varicocele repair, none of the identified predictors can definitively determine the likelihood of successful SR. Trial registration number NCT05110391

Clinical factors impacting microdissection testicular sperm extraction success in hypogonadal men with nonobstructive azoospermia

To explore factors influencing microdissection testicular sperm extraction (micro-TESE) success in hypogonadal men with nonobstructive azoospermia (NOA). A cohort study. University-affiliated male reproductive health center. A total of 616 consecutive patients with NOA and hypogonadism (total testosterone [T] levels <350 ng/dL) underwent micro-TESE between 2014 and 2021. All patients had no prior sperm retrieval (SR) history. Patients aged 23-55 years underwent comprehensive clinical, laboratory, and histopathological diagnostic evaluation for NOA and were further categorized into two cohorts on the basis of pre-SR hormonal stimulation. A multivariable logistic regression analysis explored the associations between patient variables and micro-TESE success, defined as the presence of viable spermatozoa in extracted specimens. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were computed to assess the relationship between SR success and relevant predictors. Sperm retrieval rates were compared between patients receiving or not hormonal stimulation, and logistic regression analysis evaluated the effect of baseline follicle-stimulating hormone levels (i.e., normogonadotropic vs. hypergonadotropic classes) on SR success. The overall micro-TESE success rate was 56.6%. Baseline follicle-stimulating hormone levels (aOR, 0.97; 95% CI, 0.94-0.99), pre-SR hormonal stimulation (aOR, 2.54; 95% CI, 1.64-3.93), presence of clinical varicocele (aOR, 0.05; 95% CI, 0.01-0.51), history of previous varicocelectomy (aOR, 2.55; 95% CI, 1.26-5.16), and testicular histopathology were independent predictors of SR success. Among hormone-pretreated patients, pre-micro-TESE T levels and delta T (an absolute increase in T levels from baseline) were associated with SR success. A pre-micro-TESE T level of 418.5 ng/dL (area under the curve value: 0.78) and a delta T of 258 ng/dL (area under the value: 0.76) distinguished patients with positive and negative SR outcomes. Subgroup analysis showed that pre-SR hormonal stimulation yielded a greater benefit for normogonadotropic patients than for those who were hypergonadotropic. This study underscores the association between clinical factors and micro-TESE success in hypogonadal men with NOA. Although causality is not established, our findings suggest that these patients may benefit from pre-SR interventions, particularly hormonal stimulation and varicocele repair. NCT05110391.

A study of the association between single nucleotide polymorphisms of the endoplasmic reticulum aminopeptidase 2 (ERAP2) gene and the risk of ankylosing spondylitis in Egyptians

BackgroundAnkylosing spondylitis (AS) is often regarded as the prototypical manifestation of spondylo-arthropathies that prevalently involves the axial skeleton with the potential attribution of ERAP2 polymorphisms to AS predisposition. The purpose of this study was to determine the genetic association between ERAP2 gene rs2910686, and rs2248374 single nucleotide polymorphisms (SNPs) and the risk of ankylosing spondylitis in the Egyptian population.Methods and resultsA cross-sectional work involved 200 individuals: 100 AS individuals diagnosed based on modified New York criteria in 1984 with 100 healthy controls matched in age and gender. The study included a comprehensive evaluation of historical data, clinical examinations, and evaluation of the activity of the disease using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). A comprehensive laboratory and radiological evaluation were conducted, accompanied by an assessment and genotyping of the ERAP2 gene variants rs2248374 and rs2910686. This genotyping was performed utilizing a real-time allelic discrimination methodology.Highly statistically substantial variations existed among the AS patients and the healthy control group regarding rs2910686 and rs2248374 alleles. There was a statistically significant difference between rs2910686 and rs2248374 regarding BASDAI, BASFI, mSASSS, ASQoL, V.A.S, E.S.R, and BASMI in the active AS group.ConclusionsERAP2 gene SNPs have been identified as valuable diagnostic biomarkers for AS patients in the Egyptian population being a sensitive and non-invasive approach for AS diagnosis especially rs2910686. Highly statistically significant variations existed among the AS patients and the healthy control group regarding rs2910686 alleles and genotypes.Further research is recommended to explore the potential therapeutic implications of these SNPs.

AORTIC STENOSIS AND HEART FAILURE: DIFFERENCES AND SIMILARITIES BEYOND PRESERVED EJECTION FRACTION

Objective: Degenerative aortic stenosis (AS) is highly prevalent in Western countries and shows a strong association with age and other cardiovascular risk factors such as arterial hypertension, diabetes mellitus, dyslipidaemia, and visceral obesity. The same risk factors are involved in the development of heart failure with preserved ejection fraction (HFpEF). Notwithstanding several similarities, patients with AS and preserved left ventricular ejection fraction (ASpEF) are not considered to actually have HFpEF. We sought to investigate the haemodynamic and metabolic features of patients with ASpEF both at rest and during physical effort and highlight similarities and differences with HFpEF. Design and method: We enrolled 148 patients with HFpEF, 150 with ASpEF (with at least moderate aortic transvalvular gradient), and 80 age- and sex-matched healthy controls. All patients received a comprehensive laboratory evaluation, a resting echocardiographic examination, and a combined cardiopulmonary-echocardiographic stress test. Patients with ASpEF who fulfilled the criteria for transcatheter aortic valve replacement (n=125) underwent cardiac computed tomography to measure aortic valve calcium score and volume. Results: Serum levels of N-terminal prohormone of brain natriuretic peptide were similar between HFpEF and ASpEF patients after excluding subjects with atrial fibrillation. As a marker of deregulated inflammation, epicardial adipose tissue (EAT) thickness was significantly greater in ASpEF than HFpEF and controls and was inversely related to peak oxygen consumption (VO2) in all subgroups (Figure). Furthermore, all patients showed a significant impairment in peak VO2 caused by a reduction in bith cardiac output (CO) and peripheral arteriovenous oxygen difference (AVO2diff). HFpEF patients displayed increased arterial stiffness, worse left ventricular-arterial coupling, and worse left atrial function. On the other hand, patients with ASpEF showed worse right ventricular-pulmonary arterial coupling. In ASpEF, disease severity, evaluated by aortic transvalvular peak velocity, mean gradient at rest and peak exercise, and aortic valve calcium score and volume, was directly related to EAT thickness. Conclusions: ASpEF shows substantial similarities to HFpEF. ASpEF could represent a separate phenotype in the spectrum of HFpEF; further and larger studies should investigate this hypothesis to give further insight into the pathophysiology of ASpEF.

Characterizing autoimmune uveitis to systemic diseases: a retrospective study from a Syrian tertiary reference center.

Uveitis, a notable cause of severe visual impairment, is frequently characterized as infectious or noninfectious autoimmune uveitis (AU), the latter of which is commonly associated with younger individuals and systemic diseases. Despite the condition's widespread impact, there are substantial gaps in the comprehension of its pathogenesis, clinical presentation, and therapeutic response, particularly concerning systemic disease-associated uveitis. The current study aims to bridge these gaps through an extensive examination of demographic and clinical features in AU patients, thereby informing future research, and therapeutic strategies, and improving patient outcomes. This retrospective observational study analyzed 261 patients with systemic disease-associated uveitis from January 2018 to December 2022 in Damascus, Syria. With diagnoses made using the Standardization of Uveitis Nomenclature Working Group Criteria, the study evaluated tailored treatment efficacy at the 24-month post-treatment mark, alongside comprehensive ophthalmic examinations, laboratory evaluations, and radiographic assessments. In our study, included 87 patients with Systemic Disease-Associated Autoimmune Uveitis (SDA-AU). Women represented 64.36% of this group, and the mean age at diagnosis was 39.8±17.9 years (range 7-71) for men and 43.8±15.4 years (range 11-69). The most reported symptom was a painful red eye (52.87%). The onset of symptoms was sudden for 32.18% of patients, while 67.81% reported gradual development. Complications occurred in 33.33% of patients, including cataracts (41.37% of those with complications) and glaucoma (17.24%). Laboratory evaluations showed elevated inflammation markers in 66.66% of patients. Upon the 24-month assessment, 48.27% of patients achieved complete remission, 37.93% showed significant improvement, while disease worsened in 13.79% of cases. Our findings demonstrated that the presentation of AU in this cohort frequently precedes the diagnosis of systemic diseases, affirming the vital role of an early and accurate diagnosis of uveitis for the detection of underlying systemic conditions. In conclusion, our study underlines the significance of a comprehensive and multidisciplinary approach in the management of SD-AU, leading to improved prognosis and quality of life for patients.

Laboratory Characterization of Additive-Modified Asphalt Concrete Mixtures

There is a need for a more rapid system of evaluation and implementation for new and existing asphalt additives, especially because of the prohibitive cost of full-scale performance evaluations. To help to meet this need, the Additive Group (AG) experiment at the National Center for Asphalt Technology (NCAT) was developed and began in 2021. A comprehensive laboratory evaluation of six mixtures, each modified with a popular additive type selected by the AG state DOT sponsors, was conducted. Simultaneously, full-scale test sections were constructed at the NCAT test track to evaluate the field performance and structure behavior of each modified mixture. Trafficking of these test sections is currently underway, and estimated to be completed in 2024, at which point an investigation linking the laboratory and field results will be done. This paper presents the completed laboratory evaluation of each AG mixture via complex dynamic modulus (E*), direct tension cyclic fatigue, and bending beam fatigue testing. The wet-process rubber modified mixture was found to have reduced E* and initial flexural stiffness, but increased fatigue resistance, relative to the styrene-butadiene-styrene (SBS)-modified control mixture. The dry-process rubber-modified mixture displayed similar trends, though to a lesser degree. Conversely, the dry-process plastic-modified mixture was found to have increased E* and initial flexural stiffness, but reduced fatigue resistance, relative to the SBS-modified control mixture. The other AG mixtures—a dry-process fiber and a wet-process plastic-modified mixture—were found to display E*, initial flexural stiffness, and fatigue resistance similar to that of the SBS-modified control mixture.

Late Presentation of Early-onset Sarcoidosis: A Case Report

Background: Early-onset sarcoidosis is a rare systemic inflammatory granulomatous disease, distinguished by onset before the age of 4 and notably lacking pulmonary involvement. Unfortunately, the condition often shows clinical features similar to juvenile idiopathic arthritis, resulting in the misdiagnosis of numerous patients. This case report delves into the challenges associated with the delayed diagnosis of early-onset sarcoidosis, with a particular focus on the diagnostic methods employed to address this delayed recognition. Case presentation: A 15-year-old girl presented with a history of recurrent fever since infancy, accompanied by rash, arthritis, and joint deformity. Previously misdiagnosed with juvenile idiopathic arthritis, she underwent management with steroids and methotrexate, yielding no improvement. The diagnosis of early-onset sarcoidosis was made during adolescence based on serial examinations, comprehensive laboratory and radiological evaluations, and subsequent histopathology findings. Presently, the patient is receiving treatment with low-dose steroids and biologic therapy (Tocilizumab) and experiencing no disease progression. Conclusion: This case report underscores the importance of considering early-onset sarcoidosis in the differential diagnosis of pediatric patients exhibiting persistent arthritis from an early age. Early detection and treatment are crucial in averting complications and enhancing the overall quality of life.

Evaluation of gastric biopsy results and laboratory parameters in enterobiasis: Insights from a case-control study

Enterobius vermicularis, commonly known as pinworm, is a prevalent intestinal parasite that can cause various gastrointestinal symptoms. Despite its ubiquity, the impact of enterobiasis on gastric biopsy results and laboratory parameters has not been thoroughly investigated. This study compares gastric biopsy findings and laboratory parameters between patients with and without enterobius infection. This case-control study enrolled 71 patients presenting with dyspeptic complaints. All participants underwent upper and lower gastrointestinal endoscopy. The study group consisted of 21 patients with confirmed pinworm infection on colonoscopic examination, while the control group comprised 50 patients without pinworm infection. Demographic data, laboratory parameters, and gastric biopsy results (intestinal metaplasia, atrophy, Helicobacter pylori) were collected and analysed. The study included 21 patients with enterobiasis and 50 patients without enterobiasis. There was no significant difference in gastric biopsy findings between the study and control groups. However, the laboratory parameters of haemoglobin, hematocrit, potassium, albumin, aspartate aminotransferase, and C-reactive protein differed significantly. Hemoglobin and hematocrit values were lower, and C-reactive protein values were higher in the enterobiasis group, while potassium, albumin, and aspartate aminotransferase values were higher in the control group (p&lt;0.05). This study demonstrates that while enterobius infection does not significantly alter gastric biopsy findings, it is associated with significant changes in several laboratory parameters. These findings suggest that enterobiasis may have systemic effects beyond the gastrointestinal tract, highlighting the importance of comprehensive laboratory evaluation in affected patients. Further research is warranted to elucidate the clinical implications of these laboratory alterations in enterobiasis.

Dynamic Evaluation of Vitamin D Metabolism in Post-Bariatric Patients.

findings from the previously conducted studies indicate altered regulatory mechanisms of calcium and vitamin D metabolism in obese patients and a role for bariatric surgery in regulating vitamin D metabolism; however, the available data is controversial and does not provide an adequate understanding of the subject. we evaluated serum parameters of vitamin D and mineral metabolism (vitamin D metabolites (25(OH)D3, 25(OH)D2, 1,25(OH)2D3, 3-epi-25(OH)D3, and 24,25(OH)2D3), vitamin D-binding protein (DBP), free 25(OH)D, fibroblast growth factor 23 (FGF-23), parathyroid hormone (PTH), total calcium, albumin, phosphorus, creatinine, magnesium) in 30 patients referred for bariatric surgery in comparison with 30 healthy volunteers of similar age, sex and baseline 25(OH)D3. Patients were also followed up with repeated laboratory assessments 3 months and 6 months after surgery. During the first 3 months, patients were prescribed high-dose cholecalciferol therapy (50,000 IU per week), with subsequent correction based on the results of the 3-month visit examination. Preoperatively, patients with morbid obesity were characterized by a high prevalence of vitamin D deficiency (median 25(OH)D3 level 11.9 (6.8; 22.2) ng/mL), significantly lower levels of active vitamin D metabolite 1,25(OH)2D3 (20 (10; 37) vs. 39 (33; 50) pg/mL, p < 0.001), lower serum albumin-adjusted calcium levels (2.24 (2.20; 2.32) vs. 2.31 (2.25; 2.35) mmol/L, p = 0.009) and magnesium levels (0.79 (0.72; 0.82) vs. 0.82 (0.78; 0.85) mmol/L, p = 0.043) with simultaneous similar PTH levels (p = 0.912), and higher DBP levels (328 (288; 401) vs. 248 (217; 284) mg/L, p < 0.001). The 25(OH)D3 levels remained suboptimal (24.5 (14.7; 29.5) ng/mL at the 3-month visit and 17.9 (12.4; 21.0) ng/mL at the 6-month visit, p = 0.052) despite recommended high-dose cholecalciferol supplementation. Patients also demonstrated an increase in 1,25(OH)2D3 levels (38 (31; 52) pg/mL at the 3-month visit and 49 (29; 59) pg/mL at the 6-month visit, p < 0.001) without a change in PTH or calcium levels during the follow-up. our results of a comprehensive laboratory evaluation of vitamin D status and mineral metabolism in patients undergoing bariatric surgery highlight the importance of improving current clinical guidelines, as well as careful monitoring and education of patients.

Toward Optimal Irrigation Management at the Plot Level: Evaluation of Commercial Water Potential Sensors.

Proper irrigation practice consists of applying the optimum amount of water to the soil at the right time. The porous characteristics of the soil determine the capacity of the soil to absorb, infiltrate, and store water. In irrigation, it is not sufficient to only determine the water content of the soil; it is also necessary to determine the availability of water for plants: water potential. In this paper, a comprehensive laboratory evaluation-accuracy and variability-of the world's leading commercial water potential sensors is carried out. No such comprehensive and exhaustive comparative evaluation of these devices has been carried out to date. Ten pairs of representative commercial sensors from four different families were selected according to their principle of operation (tensiometers, capacitive sensors, heat dissipation sensors, and resistance blocks). The accuracy of the readings (0 kPa-200 kPa) was determined in two soils of contrasting textures. The variability in the recordings-repeatability and reproducibility-was carried out in a homogeneous and inert material (sand) in the same suction range. The response in terms of accuracy and value dispersion of the different sensor families was different according to the suction range considered. In the suction range of agronomic interest (0-100 kPa), the heat dissipation sensor and the capacitive sensors were the most accurate. In both families, registrations could be extended up to 150-200 kPa. The scatter in the readings across the different sensors was due to approximately 80% of the repeatability or intrinsic variability in the sensor unit and 20% of the reproducibility. Some sensors would significantly improve their performance with ad hoc calibrations.

Utilizing dehydroepiandrosterone sulfate and its ratio for detecting mild autonomous cortisol excess in patients with adrenal incidentaloma.

Subclinical Cushing syndrome is a condition of mild autonomous cortisol excess (MACE) that lacks typical features of Cushing syndrome but is associated with many complications. It represents a common hormonal dysfunction among patients with adrenal incidentaloma (AI), defined as unexpected masses or lesions found in the adrenal glands during radiological examinations of the chest or abdomen unrelated to adrenal gland assessment. The study evaluated the accuracy of dehydroepiandrosterone sulfate (DHEA-S) and dehydroepiandrosterone sulfate ratio (calculated by dividing the DHEA-S value by the age and sex-adjusted normal range of DHEA-S) in detecting MACE in AI patients. A cross-sectional study was conducted from April 2021 to July 2022 at the Faiha Specialized Diabetes, Endocrine, and Metabolism Centre (FDEMC) in Basrah, southern Iraq, involving 38 AI patients. Comprehensive laboratory and radiological evaluations were performed, including tests for adrenocorticotropic hormone (ACTH), renin, aldosterone, aldosterone/renin ratio (ARR), metanephrine, normetanephrine, cortisol, DHEA-S, and the 1-mg overnight dexamethasone suppression test (1-mg ONDST). Among the AI patients, 14% had MACE. Both DHEA-S ≤75 µg/dL and a DHEA-S ratio ≤1.7 exhibited a sensitivity of 80% each, with specificities of 73.3% and 76.6%, respectively, in diagnosing MACE in individuals aged ≤65 years. The negative predictive values were 95.7% and 95.8%, respectively. Low DHEA-S and DHEA-S ratio had high sensitivity and specificity in predicting MACE among AI patients aged ≤65 years, with strong negative predictive value.

Towards nationwide implementation of 40% biodiesel blend fuel in Indonesia: a comprehensive road test and laboratory evaluation

This research focused on evaluating the technical viability of using biodiesel with a blending ratio of 40% v/v, which is expected to be implemented soon in Indonesia. Two kinds of biodiesel blends were prepared, a blend of 60% diesel fuel and 40% biodiesel (B40) and a blend of 60% diesel fuel, 30% biodiesel, and 10% hydrogenated vegetable oil (HVO) (B30D10). The fuels were tested on EuroII vehicles without any engine modifications through a 50,000 km endurance road test. Laboratory tests were also performed at certain traveled distances to evaluate various engine parameters, including power, fuel economy, exhaust emissions, and used engine oil properties. Engine components were inspected upon the completion of the road test. Cold-start ability was also examined to confirm the suitability of the investigated biofuels at low-temperature operating conditions in Indonesia. The road test results showed that vehicles fuelled with B40 and B30D10 could reach a distance of 50,000 km without encountering any technical issues. The laboratory evaluation during the road test indicated that B30D10 had a higher power and fuel economy than B40, with a maximum difference of 2%. Furthermore, B30D10 emitted lower CO, HC, and PM emissions than B40 throughout the distance traveled, with maximum differences of 11.4%, 14.7%, and 22.6%, respectively, but led to 15% higher NOx. Engine component inspection and used engine oil analysis confirmed the fulfillment of the manufacturer's recommendations for both B40 and B30D10. Finally, B40 and B30D10 were suitable for operating at low ambient temperatures in Indonesia, confirming them as practical options to be implemented in the nationwide 40% biodiesel blend fuel.

Takayasu arteritis associated with autoimmune/inflammatory syndrome induced by adjuvants: a case-based review.

Takayasu's arteritis (TA) is a chronic granulomatous vasculitis that predominantly affects the aorta and its major branches. Despite advancements in the understanding of the pathogenic pathways of vascular inflammation, the etiology and predisposing factors of TA remain to be fully understood. In susceptible individuals, exposure to adjuvants may trigger, unlock or unmask an autoimmune disorder, presenting as non-specific constitutional symptoms or a fully developed autoimmune syndrome such as vasculitis. Here, we hypothesize that TA could be triggered by siliconosis, a subtype of the autoimmune/inflammatory syndrome induced by adjuvants (ASIA). ASIA, also known as Shoenfeld syndrome, encompasses a wide range of autoimmune and immune-mediated diseases resulting from dysregulation of the immune response after exposure to agents with adjuvant activity. This case report describes the development of large artery vasculitis, TA, in an individual one year following the placement of silicone breast implants. The patient initially presented with non-specific symptoms, and multiple imaging methods were employed, including ultrasound diagnostics, CT angiography, and 18-fluorodeoxyglucose positron emission tomography/CT. These techniques revealed vasculitic alterations in the carotid arteries and thoracic aorta. Initial treatment with glucocorticosteroids proved ineffective, prompting the addition of steroid-sparing immunosuppressive agents. Due to the distinct clinical symptoms, disease progression, implant-associated fibrosis, and resistance to therapy, the potential involvement of implants in the development of large-vessel vasculitis was considered, and a potential association with ASIA was postulated. Although there is limited evidence to support a direct link between adjuvants and the pathogenesis of TA, similarities in cellular immunity between the two conditions exist. The diagnosis of this complex and potentially debilitating condition requires a comprehensive clinical examination, laboratory evaluation, and instrumental assessment. This will aid in identifying potential contributing factors and ensuring successful treatment.

Padded Helmet Shell Covers in American Football: A Comprehensive Laboratory Evaluation with Preliminary On-Field Findings.

Protective headgear effects measured in the laboratory may not always translate to the field. In this study, we evaluated the impact attenuation capabilities of a commercially available padded helmet shell cover in the laboratory andon the field. In the laboratory, we evaluated the padded helmet shell cover's efficacy in attenuating impact magnitude across six impact locations and three impact velocities when equipped to three different helmet models. In a preliminary on-field investigation, we used instrumented mouthguards to monitor head impact magnitude in collegiate linebackers during practice sessions while not wearing the padded helmet shell covers (i.e., bare helmets) for one season and whilst wearing the padded helmet shell covers for another season. The addition of the padded helmet shell cover was effective in attenuating the magnitude of angular head accelerations and two brain injury risk metrics (DAMAGE, HARM) across most laboratory impact conditions, but did not significantly attenuate linear head accelerations for all helmets. Overall, HARM values were reduced in laboratory impact tests by an average of 25% at 3.5m/s (range: 9.7 to 39.6%), 18% at 5.5m/s (range: -5.5 to 40.5%), and 10% at 7.4m/s (range: -6.0 to 31.0%). However, on the field, no significant differences in any measure of head impact magnitude were observed between the bare helmet impacts and padded helmet impacts. Further laboratory tests were conducted to evaluate the ability of the padded helmet shell cover to maintain its performance after exposure to repeated, successive impacts and across a range of temperatures. This research provides a detailed assessment of padded helmet shell covers and supports the continuation of in vivo helmet research to validate laboratory testing results.