Crucial Test Research Articles

Revealing the Nature of yrast States in Neutron-Rich Polonium Isotopes

Polonium isotopes having two protons above the shell closure at Z=82 show a wide variety of low-lying, high-spin isomeric states across the whole chain. The structure of neutron-deficient isotopes up to Po210 (N=126) is well established as they are easily produced through various methods. However, there is not much information available for the neutron-rich counterparts for which only selective techniques can be used for their production. We report on the first fast-timing measurements of yrast states up to the 8+ level in Po214,216,218 isotopes produced in the β− decay of Bi214,216,218 at ISOLDE, CERN. In particular, our new half-life value of 607(14) ps for the 81+ state in Po214 is nearly 20 times shorter than the value available in the literature and comparable with the newly measured half-lives of 409(16) and 628(25) ps for the corresponding 81+ states in Po216,218, respectively. The measured B(E2;81+→61+) transition probability values follow an increasing trend relative to isotope mass, reaching a maximum for Po216. The increase contradicts the previous claims of isomerism for the 8+ yrast states in neutron-rich Po214 and beyond. Together with the other measured yrast transitions, the B(E2) values provide a crucial test of the different theoretical approaches describing the underlying configurations of the yrast band. The new experimental results are compared to shell-model calculations using the KHPE and H208 effective interactions and their pairing-modified versions, showing an increase in configuration mixing when moving toward the heavier isotopes. Published by the American Physical Society 2025

Production of double strange hypernuclei and exotic nuclei in central Au+Au collisions at sNN = 3 GeV

We extend the theoretical approach which includes the dynamical and statistical stages for the description of the nucleosynthesis in central collisions of relativistic ions. Previously, this approach was successfully applied to describe experimental data on both normal nuclei and single strange hypernuclei production in the GSI and RHIC-BES energy range. We predict the multiplicities of double strange hypernuclei up to ΛΛ4H and further intermediate mass nuclei up to 8Be for Au+Au central collisions at sNN = 3 GeV, recently explored by the STAR experiments. These nuclei can be identified by the measurement of the correlated particles coming after their decay. Such observations are a crucial test for the nucleosynthesis mechanism.

Intelligent consensus-based predictions of early life stage toxicity in fish tested in compliance with OECD Test Guideline 210.

Early life stage (ELS) toxicity testing in fish is a crucial test procedure used to evaluate the long-term effects of a wide range of chemicals, including pesticides, industrial chemicals, pharmaceuticals, and food additives. This test is particularly important for screening and prioritizing thousands of chemicals under the Registration, Evaluation, Authorization, and Restriction of Chemicals (REACH) regulation. In silico methods can be used to estimate the toxicity of a chemical when no experimental data is available and to reduce the cost, time, and resources involved in the experimentation process. In the present study, we developed predictive Quantitative Structure-Activity Relationship (QSAR) models to assess chronic effects of chemicals on ELS in fish. Toxicity data for ELS in fish was collected from two different sources, i.e. J-CHECK and eChemPortal, which contain robust study summaries of experimental studies performed according to OECD Test Guideline 210. The collected data included two types of endpoints - the No Observed Effect Concentration (NOEC) and the Lowest Observed Effect Concentration (LOEC), which were utilized to develop the QSAR models. Six different partial least squares (PLS) models with various descriptor combinations were created for both endpoints. These models were then employed for intelligent consensus-based prediction to enhance predictability for unknown chemicals. Among these models, the consensus model - 3 (Q2F1 = 0.71, Q2F2 = 0.71) and individual model - 3 (Q2F1 = 0.80, Q2F2 = 0.79) exhibited most promising results for both the NOEC and LOEC endpoints. Furthermore, these models were validated experimentally using experimental data from nine different industrial chemicals provided by Global Product Compliance (Europe) AB. Lastly, the models were used to screen and prioritize chemicals obtained from the Pesticide Properties (PPDB) and DrugBank databases.

New evidence finds young people in Mainland China are now bicultural.

This study reports new evidence that young people in Mainland China are now bicultural. We followed the established method of testing biculturalism by priming participants with images from two different cultures and measuring whether those images activate different thought styles. First, we replicated findings from 25 years ago that college students in Hong Kong are bicultural (Study 1). Next, we found that priming Mainland Chinese college students with Chinese culture increased external attributions (which are more common in China), whereas priming American culture increased internal attributions (which are more common in the US; Study 2). Next, we tested a "negative control" group that we expected should not respond to bicultural primes. Older adults who were born before China's Reform and Opening policy in 1978 showed no evidence of biculturalism (Study 3). This new evidence extends biculturalism to Mainland China, and it provides a crucial negative control test for biculturalism research.

Assessing the Utilization of HIV Genotype Resistance Testing: Insight from Italian Infectious Diseases Units.

We aimed to assess the utilization of Genotype Resistance Testing (GRT) by Infectious Diseases Units across Italy. A cross-sectional study was conducted involving a questionnaire distributed to the Infectious Diseases Unit in Italy. A web-based survey using Google Forms software was utilized and spread via email or cellphone. Responses were obtained from 101 Infectious Diseases Units. Among these centers, only seven (6.9%) reported not performing GRT at any time. Of the 94 centers performing GRT, 52 (55.3%) sent blood samples to external laboratories. Notably, only 6/35 (17.1%) small centers had internal laboratories, compared to 14/35 (40.0%) medium centers and 22/24 (91.7%) large centers (p<0.001). Most centers requested GRT for treatment-naïve individuals and all cases of virological failure. Only 24 (25.5%) requested GRT of HIVDNA before treatment changes. Regarding virological failure, most centers (38, 40.4%) requested GRT when HIV-RNA levels exceeded 200 copies/mL, while 26 (27.7%) requested it at levels exceeding 50 copies/mL. Additionally, 18 (19.1%) and 12 (12.8%) centers requested GRT at thresholds of 500 copies/mL and 1000 copies/mL, respectively. Regarding the specific GRT test used, 34 (36.2%) were unsure, while 16 (17.0%) reported using both Next-Generation Sequencing (NGS) and Sanger methods. Furthermore, 30 (31.9%) and 14 (14.9%) centers exclusively used NGS and Sanger, respectively. Most centers reported receiving GRT results within one month (n=72, 76.6%), while 22 (23.4%) centers obtained results within two weeks. However, 22 (23.4%) centers typically experienced more than one-month delays. Finally, most participants (86, 91.5%) regarded GRT as a crucial routine test for the treatment of naïve PLWH. This study demonstrates that most Infectious Diseases Units in Italy continue to consider GRT an essential test for newly diagnosed PLWH in clinical practice. However, the utilization of GRT on HIV-DNA remains limited. Further efforts are required to decrease turnaround time in centers experiencing prolonged delays in obtaining results.

Multiplicity of Galactic Cepheids from long-baseline interferometry

Aims. We aim to accurately measure the dynamical mass and distance of Cepheids by combining radial velocity measurements with interferometric observations. Cepheid mass measurements are particularly necessary for solving the Cepheid mass discrepancy, while independent distance determinations provide a crucial test of the period–luminosity relation and Gaia parallaxes. Methods. We used the multi-telescope interferometric combiner, the Michigan InfraRed Combiner (MIRC) of the Center for High Angular Resolution Astronomy (CHARA) Array, to detect and measure the astrometric positions of the high-contrast companion orbiting the Galactic Cepheid SU Cygni. We also present new radial velocity measurements from ultraviolet spectra taken with the Hubble Space Telescope. The combination of interferometric astrometry with optical and ultraviolet spectroscopy provided the full orbital elements of the system, in addition to component masses and the distance to the Cepheid system. Results. We measured the mass of the Cepheid, MA = 4.859 ± 0.058 M⊙, and its two companions, MBa = 3.595 ± 0.033 M⊙ and MBb = 1.546 ± 0.009 M⊙. This is the most accurate existing measurement of the mass of a Galactic Cepheid (1.2%). Comparing with stellar evolution models, we show that the mass predicted by the tracks is higher than the measured mass of the Cepheid, which is similar to the conclusions of our previous work. We also measured the distance to the system to be 926.3 ± 5.0 pc, obtaining an unprecedented parallax precision of 6 μas (0.5%), which is the most precise and accurate distance for a Cepheid. This precision is similar to what is expected by Gaia for its last data release (DR5 in ∼2030) for single stars fainter than G = 13, but is not guaranteed for stars as bright as SU Cyg. Conclusions. We demonstrate that evolutionary models remain incapable of accurately reproducing the measured mass of Cepheids, often predicting higher masses for the expected metallicity, even when factors such as rotation or convective core overshooting are taken into account. Our precise distance measurement allowed us to compare predictions from some period–luminosity relations. We find a disagreement of 0.2–0.5 mag with relations calibrated from photometry, while relations calibrated from a direct distance measurement are in better agreement.

95 GeV excesses in the Z3 -symmetric next-to-minimal supersymmetric standard model

Recent analyses by CMS and ATLAS suggest a deviation in the diphoton channel at approximately 95 GeV, alongside a previously observed excess in bb¯ signals at a similar mass by the Large Electron-Positron collider, potentially hinting at a new scalar particle. This study explores this possibility within the framework of the Z3-symmetric next-to-minimal supersymmetric standard model. A comprehensive parameter scan was conducted, integrating constraints from dark matter relic density, direct detection experiments, and the properties of the observed 125 GeV Higgs boson. The results demonstrate that the model can accommodate the observed excesses with a singlet-dominated CP-even scalar boson near 95 GeV. The model accurately predicts signal strengths of the diphoton and bb¯ channels at a level of 1σ. Furthermore, it accounts for the measured dark matter relic abundance through bino-dominated neutralinos coannihilation with winolike electroweakinos, all while remaining consistent with existing Large Hadron Collider (LHC) constraints. These findings pave the way for future validation at the high-luminosity LHC and linear colliders, which may offer crucial tests of the model’s predictions. Published by the American Physical Society 2024

Sustainability in the prosecution of the crime of aggression: reflections in the wake of Russia’s initiation of a war of aggression against Ukraine*

The long period of sidelining the crime of aggression in the international legal policy discourse is over. On the contrary, in the wake of Russia’s initiation of a war of aggression against Ukraine, there is strong and widespread rhetoric in international politics suggesting that a critical moment in history has been reached with respect to the prosecution of the crime of aggression. However, to ensure the sustainability of such prosecutions, powerful rhetoric is not enough. As regard the resolve to match words with deeds, the odds are still out. At the time of writing, it remains an open question whether a critical number of State leaders will be prepared to rise to the historical challenge before them and eventually pave the way for sustainable prosecution of the crime of aggression. The crucial test is whether States Parties to the ICC Statute are ready, within the immediate future, to overcome the debilitating jurisdictional restraints that govern the Court’s exercise of jurisdiction over the crime of aggression.

Bioinspired Janus Mesh with Mechanical Support and Side-specific Biofunctions for Hernia Repair.

Postoperative adhesion (PA) caused by the combination of proteins, inflammatory response and bacterial infection poses substantial challenges for polypropylene meshes (PPMs) based hernioplasty. Herein, inspired by the peritoneum, a Janus PPMs with side-specific functions was developed via a surface-initiated photoiniferter-mediated polymerization technology. A physical barrier composed of zwitterionic polymer brushes (PS) was firstly constructed on the one side of the PPMs, while the polymethacrylic acid (PMAA) brushes acting as the linker for bioactive nanoparticles (HAP) were precisely situated on the opposite surface subsequently. Our findings reveal that the mesh surface modified with PS demonstrated significant antifouling property that more than 99% of protein adhesion could be inhibited even after the co-incubation for 72 h in the crucial test. Meanwhile, on the other surface of the PPMs modified with HAP achieved satisfactory ROS-scavenging, inflammation-inhibiting and cell adhesion-promoting properties as well as good bactericidal performance (killing rate > 99.9%). Furthermore, the Janus PPMs could maintain comparable mechanical property with pristine meshes. Equipped with the above multiple merits and asymmetric property, the constructed Janus PPMs demonstrated effective treatment for abdominal hernia defects in vivo without any PA formation. Overall, this study duplicates the unique characteristics of peritoneum onto PPMs to successfully address postoperative complications of the hernioplasty and also offers a versatile and innovative idea to construct asymmetrical functions on the one implant. STATEMENT OF SIGNIFICANCE: The implantation of surgical meshes in the hernia defect provides additional firm support to reinforce the abdomen fascia in tension-free way. However, multiple post-surgery complications induced tissue adhesions is of great challenges for commercial mesh-based hernioplasty. Although material designing and surface modification might circumvent these limitations partly, the construction of side-specific biofunctions on the commercial mesh surfaces is very challenging because of its porous structure. Herein, we demonstrate a feasible and promising approach to construct asymmetric biofunctions on the opposite sides of network structured polypropylene mesh, which is rarely achieved previously. The fabricated Janus PPMs maintains the inherent long-term mechanical support; meanwhile, the opposite sides of PPMs could perform multiple biofunctions independently.

Simple Fluctuations in Simple Glass Formers.

Critical single-particle fluctuations associated with particle displacements are inherent to simple glass-forming liquids in the limit of large dimensions and leave a pseudocritical trace across all finite dimensions. This characteristic could serve as a crucial test for distinguishing between theories of glass formation. We here examine these critical fluctuations, as captured by the well-established non-Gaussian parameter, within both mode-coupling theory (MCT) and dynamical mean-field theory (DMFT) across dimensions for hard sphere fluids and for the minimally structured Mari-Kurchan model. We establish general scaling laws relevant to any liquid dynamics theory in large dimensions and show that the dimensional scalings predicted by MCT are inconsistent with those from DMFT. Simulation results for hard sphere fluids in moderately high dimensions align with the DMFT scenario, reinforcing the relevance of mean-field theory for capturing glass physics in finite dimensions. We identify potential adjustments to MCT to account for certain mean-field physics. Our findings also highlight that local structure and spatial dimensionality can affect single-particle critical fluctuations in nontrivial ways.

Sustainability in the prosecution of the crime of aggression: reflections in the wake of Russia’s initiation of a war of aggression against Ukraine

The long period of sidelining the crime of aggression in the international legal policy discourse is over. On the contrary, in the wake of Russia’s initiation of a war of aggression against Ukraine, there is strong and widespread rhetoric in international politics suggesting that a critical moment in history has been reached with respect to the prosecution of the crime of aggression. However, to ensure the sustainability of such prosecutions, powerful rhetoric is not enough. As regard the resolve to match words with deeds, the odds are still out. At the time of writing, it remains an open question whether a critical number of State leaders will be prepared to rise to the historical challenge before them and eventually pave the way for sustainable prosecution of the crime of aggression. The crucial test is whether States Parties to the ICC Statute are ready, within the immediate future, to overcome the debilitating jurisdictional restraints that govern the Court’s exercise of jurisdiction over the crime of aggression.

Diagnóstico asistido por computadora en mamografías para detección del cáncer de mama

Securing access to quality healthcare services, particularly for essential screening tests like mammograms, presents a significant challenge in developing nations. Women often encounter extensive waiting periods, sometimes extending for several months, to undergo a mammogram. This crucial test plays a pivotal role in the early detection of breast cancer, where timely diagnosis is crucial for effective treatment and enhanced survival prospects. Delays in obtaining a diagnosis can significantly impact the health of patients and their well-being, underscoring the importance of early detection. Compounding these challenges is the scarcity of resources and healthcare professionals, which hinders swift and efficient access to preventive care. Such constraints underscore the pressing need for improvements in the interpretation of radiological studies and a reduction in the workload of imaging specialists. These improvements would not only optimize interdisciplinary collaboration but also enhance patient care, particularly for critical screenings like mammograms (3). Technological advancements, particularly in artificial intelligence (AI), have significantly influenced numerous sectors, including healthcare (4). Yet, in areas such as Latin America, where the healthcare infrastructure and resources may not fully support the integration of advanced diagnostic techniques based on informatic tools, the potential of these innovations seems to be underutilized. A promising application of technology is in Computer-Aided Diagnosis (CAD) for breast cancer screening with mammograms. CAD leverages vast datasets and pattern recognition algorithms to detect anomalies within mammograms, potentially facilitating the early identification of lesions. Given that breast cancer ranks among the most prevalent diseases affecting women globally, early detection is vital for enhancing patient survival rates and quality of life. Given these challenges, our study aims to examine the latest developments in artificial intelligence technology as a supplementary tool in CAD strategies for mammograms. Our goal is to foster better interdisciplinary collaboration among clinicians, radiologists, and pathologists through a state of the art (SOTA) review of the topic. By doing so, we anticipate streamlining the diagnostic workflow and elevating the efficiency of breast cancer detection and treatment processes.

Advancements in the use of AI in the diagnosis and management of inflammatory bowel disease.

Inflammatory bowel disease (IBD) causes chronic inflammation of the colon and digestive tract, and it can be classified as Crohn's disease (CD) and Ulcerative colitis (UC). IBD is more prevalent in Europe and North America, however, since the beginning of the 21st century it has been increasing in South America, Asia, and Africa, leading to its consideration as a worldwide problem. Optical colonoscopy is one of the crucial tests in diagnosing and assessing the progression and prognosis of IBD, as it allows a real-time optical visualization of the colonic wall and ileum and allows for the collection of tissue samples. The accuracy of colonoscopy procedures depends on the expertise and ability of the endoscopists. Therefore, algorithms based on Deep Learning (DL) and Convolutional Neural Networks (CNN) for colonoscopy images and videos are growing in popularity, especially for the detection and classification of colorectal polyps. The performance of this system is dependent on the quality and quantity of the data used for training. There are several datasets publicly available for endoscopy images and videos, but most of them are solely specialized in polyps. The use of DL algorithms to detect IBD is still in its inception, most studies are based on assessing the severity of UC. As artificial intelligence (AI) grows in popularity there is a growing interest in the use of these algorithms for diagnosing and classifying the IBDs and managing their progression. To tackle this, more annotated colonoscopy images and videos will be required for the training of new and more reliable AI algorithms. This article discusses the current challenges in the early detection of IBD, focusing on the available AI algorithms, and databases, and the challenges ahead to improve the detection rate.

Chitosan supported hetero-metallic bio-nanocomposites for paracetamol removal from homogeneous solutions and heterogeneous mixtures with focused antibacterial studies

Biopolymers infused with bimetallic nanoparticles exhibit a wide range of functionalities necessary for efficiently eliminating diverse water contaminants. However, the protracted production process requires further exploration. As such, present study seeks to optimize microwave-assisted technique for the facile synthesis of cross-linked chitosan (CTS) supported bimetallic-oxide nanoparticles, specifically zinc oxide (ZnO) and iron-oxide (Fe3O4), denoted as CTS-TTP/Zn-Fe. The primary objective is to investigate the efficacy of these beads in the removal of Paracetamol (PCM) from single and complex water matrices while also assessing their antibacterial properties. Characterization includes chemical composition, surface structures, thermal stability, and magnetic properties. The experimental results demonstrated that CTS-TPP/Zn-Fe beads achieved a remarkable PCM removal efficiency of ~99% (qm=4.98mgg-1), with a Zn:Fe mole ratio of 1:1. The experimental data showed good applicability with Freundlich isotherm and chemisorption-supported rate models (R2>0.9). To evaluate the long-term viability and practicality of these beads, three crucial field applicability tests were conducted. These encompassed competition studies with other pharmaceuticals, desorption investigations for repeated use, and efficiency evaluations in an ionic solution. Collectively, this research provides a comprehensive understanding, spanning from material design to practical applications, with potential relevance for large-scale wastewater treatment when coupled with appropriate flux control measures.

8169 Bilateral Inferior Petrosal Sinus Sampling Using Metyrapone as a Reliable Alternative to Differentiate Between Cushing Disease and Ectopic ACTH Syndrome- A Single Center Experience

Abstract Disclosure: M. Azmath: None. S. Faisal: None. C. Caetano: None. T. Vedere: None. H. Aftab: None. B. Tendler: None. C. Malchoff: None. Introduction: Bilateral IPSS is a crucial test in accurately diagnosing Cushing disease (CD) and differentiating it from ectopic ACTH syndrome (EAS). [1] CRH stimulated IPSS is the gold standard technique but cannot be performed due to current shortage of CRH. Metyrapone is a safe and reliable alternative to CRH that can stimulate corticotrophs to secrete ACTH and hence used for IPSS. [2] We would like to share a single center experience using a novel low dose metyrapone protocol for IPSS that successfully helped differentiate CD and EAS. Methods: This was a retrospective analysis of patients presenting with Cushing syndrome. Initial diagnosis was confirmed based on standard testing including 24-hour urinary free cortisol (UFC), late night saliva concentrations (LNSC) and MRI. Metyrapone 500 mg every 4 hours for 3 doses was administered orally starting midnight prior to IPSS performed in the morning. ACTH levels drawn during initial evaluation for Cushing syndrome was compared to ACTH values post metyrapone from the peripheral vein sample to calculate a gradient. Ultimately, pituitary CD or EAS was confirmed based on cure following surgery and /or positive ACTH of tumor staining on pathology and/or concordant results with CRH stimulated IPSS. Results: There were 9 patients, out of which 5 had pituitary CD, and 4 had EAS. Pre ACTH levels for patients ranged between 14.5 and1164 pg/ml (normal reference range 6-50). Following metyrapone, ACTH level rose to 40-4705 pg/ml (normal reference range 6-50). The increase in ACTH levels ranged from 81-547% pre and post metyrapone. An average of 5-6 ACTH samples were drawn during IPSS. Catheterization was successful in all patients and was confirmed by IR. The mean central to peripheral (C/P) ACTH ratio for patients with confirmed CD was 20.53 in comparison with a ratio of 1.34 in patients with EAS. IPSS was confirmed to be diagnostic for pituitary CD if the peak ratio after metyrapone administration was more than 3. No adverse effects were observed during or after the procedure and no hospitalization was required pre-procedure. Discussion: We present single center experience with a novel low dose metyrapone protocol for IPSS. Our protocol was successful in increasing ACTH/cortisol secretion by tumorous cells as evidenced by increase in ACTH levels post metyrapone. It is an easy oral protocol which proved to be safe without the risk for adrenal insufficiency that can occur with higher doses. It also mitigates the small thromboembolic risk that can occur with DDAVP administration. A clear distinction in C/P ACTH ratios was observed in patients with CD versus EAS as early as the 3rd sample. In conclusion, our low dose metyrapone protocol was safe and reliable in accurately differentiating between CD and EAS in small sample of patients at our institution. Presentation: 6/1/2024

Negotiated Federalism: Intergovernmental Relations on the Maritime Frontier, 1789–1815

Abstract: The U.S. Constitution was designed to produce a profound alteration in the structure of the American federal polity by giving the U.S. government the power to raise its own money and enforce its own laws within the states. But when federal officials began to implement the new constitutional order across the union in 1789, they realized that this process required the participation and consent of state governments, whose legislation, investment, and manpower were needed to allow federal laws to take effect. Because of the power that state governments continued to wield, the successful institution of federal authority within the states relied on intergovernmental negotiation. The Atlantic port cities presented a crucial test case for this negotiated federalism, as the federal government sought to exercise power in spaces where state authority was already entrenched. In the course of setting up the customs and lighthouse services, rebuilding coastal fortifications, and enforcing neutrality and embargo regulations, early federal officials encountered the limits of federal power within the states, and developed intergovernmental negotiation strategies that allowed them to execute federal law in the ports. This negotiated federalism would become fundamental to the governance of the American union.

Electrocardiographic Changes in Pediatric Patients with COVID-19

Abstract Background COVID-19 may present with cardiac involvement such as shock, elevated troponin or, pro- brain natriuretic peptide level, coronary artery involvement, ventricular dysfunction, and arrhythmia. The most frequent electrocardiographic findings are low QRS amplitude, nonspecific ST segment changes and T-wave abnormalities. PR interval prolongation and first-degree AV block are also common in patients with MIS-C. Aim of the Study To evaluate the electrocardiogram changes in pediatric patients with COVID-19. Patients and Methods The present study is a cross sectional study which included 75 patients with definite, probable or evidence of previous COVID-19 infection (based on positive PCR, IgM or IgG), who were admitted at El Demerdash Pediatrics Hospital. Each child had two electrocardiogram done (on presentation and on third day of admission). Results The median age of our population was five years. Thirty five were females and fourty were males. On presentation, our patients had regular rythm, bradycardia was found among 9 patients (12%) and tachycardia was found among 17 patients (22.7%). Four patients (5.3%) showed prolonged PR interval, one patient (1.3%)showed prolonged QRS complex, one patient showed Right axis deviation and four patients (5.3%) showed left axis deviation, prolonged QT interval was found among four patients(5.3%). Regarding T wave, there was inversion in V1 in 27 patients(37.5%) and inversion in v4 in 24 patients(32.9%). All these findings disappeared with follow up on day three of admission. Conclusion Electrocardiogram may represent a crucial test in the diagnosis of myocardial injury or heart rythm disturbances in patients with SARS-COV-2.

Woodhouse-sakati syndrome with no reportable MRI findings: a case report

BackgroundWoodhouse-Sakati Syndrome (WSS) is a rare autosomal recessive condition caused by biallelic pathogenic variants in the DCAF17 gene, with fewer than 200 cases reported in the literature. Symptoms first emerge in middle-late adolescence with a spectrum of hypogonadal and progressive neurological features.Case presentationWe present a case of WSS with no reportable T2-weighted, apparent diffusion coefficient mapping and susceptibility weighted MRI findings. This differs from cases reported in the current literature. Our patient developed abnormal movements in both legs, clumsiness of the hands, dysarthria, and swallowing difficulties. Moreover, she presented with alopecia manifesting as frontal and temporal balding, severe dystonia with painful dystonic spasms primarily in the left upper limb, as well as primary amenorrhea. She was not independently ambulatory on presentation, requiring wheelchair assistance. Genetic testing, the crucial test for a definitive diagnosis, was undertaken in Qatar and confirmed WSS. Treatment provided includes botulinum toxin injections and deep brain stimulation, providing better dystonia control, with progress in walking and strength exercises, and overall remarkable improvement. Intensive neurorehabilitation regimes were also deployed from admission, including physiotherapy, occupational therapy and speech and language therapy.ConclusionThis case adds to the current literature on WSS manifestations, with all previously reported cases having positive MRI findings, unlike our case.

ASSOCIATION OF AGE AND DIABETES DURATION WITH ESTIMATED GLOMERULAR FILTRATION RATE IN PATIENTS WITH DIABETES MELLITUS ATTENDING AL-DOFIAH MARTYR HOSPITAL-BEIHAN, SHABWAH, YEMEN

Chronic kidney disease (CKD) is a common complication of Diabetes Mellitus (DM) and limits treatment options in DM. Estimated glomerular filtration rate (eGFR) is a crucial test for renal assessment. Significant association was found between risk factors and lower eGFR. Ageing is a natural and inevitable biological process that affects all organs. In Yemen, the association between rate of kidney function decline and age or/and duration of diabees has not been well investigated. The current study aimed to determine the association between eGFR and age or/with duration of DM. 177 individuals with DM were studied for the analysis of the association between eGFR rate with age and diabetes duration during the period of February 2022 to February 2023. Results showed high significant differences found in age groups based on eGFR. However, significant difference between the values of eGFR in age groups 25-34, 45-54 and 55-64. Except in the 7 age group, the eGFR of individuals in age groups tended to decreased. In the whole section, prevalence of CKD (high and very high risk) was 16.9% and increased progressively with age. The CKD associated with each 5 year increase in diabetes duration. Of these patients, 11.3% had an eGFR of 15-29 and &lt; 15mL/min/1.73m2, and 5.6% had an eGFR of 30-44 mL/min/1.73m2. In the 4 category (15 years), 4% of study subjects were treated with stage 5 of eGFR (very high risk). The shape of the association between age with diabetes duration and risk of CKD was linear. The results of our study and the other kinds of literature indicate that the important of estimated glomerular filtration rate (eGFR) according to age, diabetes duration and degree of renal dysfunction. In conclusion: These results emphasize the importance of assessment of eGFR for CKD risk prediction in diabetes patients. Our findings suggested that early diagnosis and treatment is important for these patients. So, the observation that could guide preventative efforts of efficient glucose-lowering and renal protective strategies are needed in persons with DM.

C-reactive protein as robust laboratory value associated with prognosis in patients with stage III non-small cell lung cancer (NSCLC) treated with definitive radiochemotherapy

To evaluate the prognostic value of biomarkers from peripheral blood obtained as routine laboratory assessment for overall survival in a cohort of stage III non-small cell lung cancer (NSCLC) patients treated with definitive radiochemotherapy at a high-volume cancer center. Seven blood biomarkers from 160 patients treated with definitive radiochemotherapy for stage III NSCLC were analyzed throughout the course treatment. Parameters were preselected using univariable and multivariable proportional hazards analysis and were assessed for internal validity using leave-one-out cross validation. Cross validated classifiers including biomarkers in addition to important clinical parameters were compared with classifiers containing the clinical parameters alone. An increased C-reactive protein (CRP) value in the final week of radiotherapy was found as a prognostic factor for overall survival, both as a continuous (HR 1.099 (1.038–1.164), p < 0.0012) as well as categorical variable splitting data at the median value of 1.2 mg/dl (HR 2.214 (1.388–3.531), p < 0.0008). In the multivariable analysis, the CRP value-maintained significance with an HR of 1.105 (1.040–1.173) and p-value of 0.0012. The cross validated classifier using CRP at the end of radiotherapy in addition to clinical parameters separated equally sized high and low risk groups more distinctly than a classifier containing the clinical parameters alone (HR = 2.786 (95% CI 1.686–4.605) vs. HR = 2.287 (95% CI 1.407–3.718)). Thus, the CRP value at the end of radiation therapy has successfully passed the crucial cross-validation test. The presented data on CRP levels suggests that inflammatory markers may become increasingly important during definitive radiochemotherapy, particularly with the growing utilization of immunotherapy as a consolidation therapy for stage III NSCLC.