Early Intervention Research Articles

Medical appraisal of Chinese military aircrew with abnormal results of coronary computed tomographic angiography

BACKGROUND Coronary artery diseases can cause myocardial ischemia and hypoxia, angina pectoris, myocardial infarction, arrhythmia, and even sudden death led to inflight incapacitation of aircrew. As the main cause of grounding due to illness, they severe threats to the health and fighting strength of military aircrew. Early warning in an early and accurate manner and early intervention of diseases possibly resulting in inflight incapacitation are key emphases of aeromedical support in clinic. AIM To figure out the flight factors and clinical characteristics of military aircrew with abnormal results of coronary artery computed tomographic angiography (CTA), thereby rendering theoretical references for clinical aeromedical support of military flying personnel. METHODS The clinical data of 15 flying personnel who received physical examinations in a military medical center from December 2020 to June 2023 and were diagnosed with coronary artery diseases by coronary artery CTA were collected and retrospectively analyzed, and a descriptive statistical analysis was conducted on their onset age, aircraft type and clinical data. RESULTS The 15 military flying personnel diagnosed with coronary artery diseases by coronary artery CTA were composed of 9 pilots, 1 navigator and 5 air combat service workers. Multi-vessel disease was detected in 9 flying personnel, among which 8 (88.9%) were pilots. Flying personnel with multi-vessel disease had higher content of cholesterol, low-density lipoprotein cholesterol and apolipoprotein B than those with single-vessel disease. CONCLUSION Coronary artery diseases are the major heart disease for the grounding of flying personnel due to illness, which can lead to inflight incapacitation. Coronary artery CTA is conducive to early detection and early intervention treatment of such diseases in clinic.

Baseline factors relating to depressive symptoms at one year postoperative in patients with diffuse glioma

Abstract Background Depressive symptoms are common in patients with diffuse glioma, potentially reducing their quality of life. Understanding baseline factors associated with the development of depressive symptoms is important for psychoeducation and early intervention. This study investigates the associations of baseline patient- and tumor-related characteristics and depressive symptoms one year after surgery. Methods We combined retrospective longitudinal datasets from Amsterdam UMC and Rigshospitalet Copenhagen. Several characteristics of patients and tumors were retrieved, in particular items of their mood and functioning status. Depression instruments were harmonized to the PROMIS Depression scale through previously-developed item response theory. Functioning items were harmonized to the International Classification of Functioning, Disability and Health (ICF) domains using linking methods published previously. We analyzed the associations of 25 baseline factors with depressive symptoms one year after surgery by multivariable stepwise backward linear regression models and verified model robustness using best subset selection. Results We included 118 patients with diffuse glioma with a mean age of 48 years and a glioblastoma in 29%. Baseline depressive symptoms, lower ICF energy, and impaired ICF language functioning were associated with more depressive symptoms at follow-up in the multivariable model (R-squared: 0.379). Conclusions We identified three key baseline factors associated with depressive symptoms one year after surgery. Clinically, our findings contribute to the comprehension of predictive factors for depressive symptoms, aiding healthcare providers and patients in understanding and possibly allowing for early intervention.

Effect of electronic alerts on the care and outcomes in patients with acute kidney injury: a meta-analysis and trial sequential analysis

BackgroundAlthough electronic alerts are being increasingly implemented in patients with acute kidney injury (AKI), their effect remains unclear. Therefore, we conducted this meta-analysis aiming at investigating their impact on the care and outcomes of AKI patients.MethodsPubMed, Embase, Cochrane Library, and Clinical Trial Registries databases were systematically searched for relevant studies from inception to March 2024. Randomized controlled trials comparing electronic alerts with usual care in patients with AKI were selected.ResultsSix studies including 40,146 patients met the inclusion criteria. The pooled results showed that electronic alerts did not improve mortality rates (relative risk (RR) = 1.02, 95% confidence interval (CI) = 0.97–1.08, P = 0.44) or reduce creatinine levels (mean difference (MD) = − 0.21, 95% CI = − 1.60–1.18, P = 0.77) and AKI progression (RR = 0.97, 95% CI = 0.90–1.04, P = 0.40). Instead, electronic alerts increased the odds of dialysis and AKI documentation (RR = 1.14, 95% CI = 1.05–1.25, P = 0.002; RR = 1.21, 95% CI = 1.01–1.44, P = 0.04, respectively), but the trial sequential analysis (TSA) could not confirm these results. No differences were observed in other care-centered outcomes including renal consults and investigations between the alert and usual care groups.ConclusionsElectronic alerts increased the incidence of AKI and dialysis in AKI patients, which likely reflected improved recognition and early intervention. However, these changes did not improve the survival or kidney function of AKI patients. The findings warrant further research to comprehensively evaluate the impact of electronic alerts.

Large ventricular myxoma causing inflow and outflow obstruction of the right ventricle; A Case Report

BackgroundMyxomas are the most common primary benign heart tumors, typically found in the left atrium, with only 2–4% occurring in the right ventricle. Clinical presentations vary widely, including congestive heart failure and systemic embolic phenomena. This case report describes a rare right ventricular myxoma causing both inflow and outflow obstruction, presenting as progressive exertional dyspnea.Case PresentationA 23-year-old male presented with two weeks of worsening exertional dyspnea. He was stable but tachypneic with a systolic murmur over the tricuspid area. Elevated erythrocyte sedimentation rate (ESR) and C-Reactive protein (CRP) were noted, while other lab tests were normal. Imaging, including echocardiography and chest tomography scan (CT) revealed a 4 × 3.8 × 4.6 cm mass in the right ventricle extending to the pulmonary trunk. Surgical resection via right ventriculotomy was performed, and histopathology confirmed myxoma. The patient recovered uneventfully.ConclusionRight ventricular myxomas, though rare, can cause significant obstruction and present with diverse symptoms. Timely diagnosis using imaging techniques like echocardiography is crucial. Surgical resection remains the definitive treatment, offering excellent outcomes and low recurrence rates. Early intervention is vital to prevent serious complications and ensure favorable patient prognosis.

Pediatric coronary cameral fistula in a structurally normal heart: a case report and review of the literature

IntroductionCoronary cameral fistulas (CCFs) are rare congenital anomalies characterized by abnormal connections between a coronary artery and one of the cardiac chambers. These abnormal connections can lead to significant clinical implications, including heart failure and myocardial ischemia, necessitating timely diagnosis and intervention.Case presentationA 5-year-old Iranian boy was brought to the emergency room at Heart Hospital Center complaining of chest pain and dyspnea on exertion. He had experienced similar episodes over the past 4 months, which had not been evaluated. Physical examination revealed stable vital signs and no remarkable findings. Transthoracic echocardiography demonstrated a dilated left coronary artery with a large aneurysm and a small orifice to the right ventricular body. The left ventricular ejection fraction was 55%. Cardiac computed tomography angiography confirmed the diagnosis. Cardiac angiography showed a dilated left coronary artery and a coronary cameral fistula to the right ventricular . The aneurysm was successfully occluded using two Amplatzer™ devices.ConclusionThis case underscores the critical role of multimodal imaging in diagnosing and managing coronary cameral fistulae. Early detection and appropriate intervention are paramount in preventing the progression of symptoms and potential complications such as heart failure and myocardial ischemia. The successful closure with Amplatzer™ devices highlights the efficacy of minimally invasive techniques in treating complex cardiovascular anomalies. Regular follow-up and careful monitoring are essential to ensure long-term success and to manage any potential recurrences.Clinical key messageTimely identification and management of coronary cameral fistulae are crucial to prevent complications. Advances in imaging techniques and minimally invasive treatments, such as transcatheter closure, offer effective solutions. A multidisciplinary approach and regular follow-up are essential for comprehensive care and successful long-term management.

Role of cfDNA and ctDNA to improve the risk stratification and the disease follow-up in patients with endometrial cancer: towards the clinical application

BackgroundThere has been a rise in endometrial cancer (EC) incidence leading to increased mortality. To counter this trend, improving the stratification of post-surgery recurrence risk and anticipating disease relapse and treatment resistance is essential. Liquid biopsy analyses offer a promising tool for these clinical challenges, though the best strategy for applying them in EC must be defined. This study was designed to determine the value of cfDNA/ctDNA monitoring in improving the clinical management of patients with localized and recurrent disease.MethodsPlasma samples and uterine aspirates (UA) from 198 EC patients were collected at surgery and over time. The genetic landscape of UAs was characterized using targeted sequencing. Total cfDNA was analyzed for ctDNA presence based on the UA mutational profile.ResultsHigh cfDNA levels and detectable ctDNA at baseline correlated with poor prognosis for DFS (p-value < 0.0001; HR = 9.25) and DSS (p-value < 0.0001; HR = 11.20). This remained clinically significant when stratifying tumors by histopathological risk factors. Of note, cfDNA/ctDNA analyses discriminated patients with early post-surgery relapse and the ctDNA kinetics served to identify patients undergoing relapse before any clinical evidence emerged.ConclusionsThis is the most comprehensive study on cfDNA/ctDNA characterization in EC, demonstrating its value in improving risk stratification and anticipating disease relapse in patients with localized disease. CtDNA kinetics assessment complements current strategies to monitor the disease evolution and the treatment response. Therefore, implementing cfDNA/ctDNA monitoring in clinical routines offers a unique opportunity to improve EC management.Translational relevanceThe study demonstrates that high levels of cfDNA and detectable ctDNA at baseline are strong indicators of poor prognosis. This enables more accurate risk stratification beyond traditional histopathological factors, allowing clinicians to identify high-risk patients who may benefit from more aggressive treatment and closer monitoring. Moreover, longitudinal analysis of cfDNA/ctDNA can detect disease recurrence months before clinical symptoms or imaging evidence appear. This early warning system offers a significant advantage in clinical practice, providing a window of opportunity for early intervention and potentially improving patient outcomes.

Early versus delayed necrosectomy in pancreatic necrosis: A population-based cohort study on readmission, healthcare utilization, and in-hospital mortality

BACKGROUND Acute necrotizing pancreatitis is a severe and life-threatening condition. It poses a considerable challenge for clinicians due to its complex nature and the high risk of complications. Several minimally invasive and open necrosectomy procedures have been developed. Despite advancements in treatment modalities, the optimal timing to perform necrosectomy lacks consensus. AIM To evaluate the impact of necrosectomy timing on patients with pancreatic necrosis in the United States. METHODS A national retrospective cohort study was conducted using the 2016-2019 Nationwide Readmissions Database. Patients with non-elective admissions for pancreatic necrosis were identified. The participants were divided into two groups based on the necrosectomy timing: The early group received intervention within 48 hours, whereas the delayed group underwent the procedure after 48 hours. The various intervention techniques included endoscopic, percutaneous, or surgical necrosectomy. The major outcomes of interest were 30-day readmission rates, healthcare utilization, and inpatient mortality. RESULTS A total of 1309 patients with pancreatic necrosis were included. After propensity score matching, 349 cases treated with early necrosectomy were matched to 375 controls who received delayed intervention. The early cohort had a 30-day readmission rate of 8.6% compared to 4.8% in the delayed cohort (P = 0.040). Early necrosectomy had lower rates of mechanical ventilation (2.9% vs 10.9%, P &lt; 0.001), septic shock (8% vs 19.5%, P &lt; 0.001), and in-hospital mortality (1.1% vs 4.3%, P = 0.01). Patients in the early intervention group incurred lower healthcare costs, with median total charges of $52202 compared to $147418 in the delayed group. Participants in the early cohort also had a relatively shorter median length of stay (6 vs 16 days, P &lt; 0.001). The timing of necrosectomy did not significantly influence the risk of 30-day readmission, with a hazard ratio of 0.56 (95% confidence interval: 0.31-1.02, P = 0.06). CONCLUSION Our findings show that early necrosectomy is associated with better clinical outcomes and lower healthcare costs. Delayed intervention does not significantly alter the risk of 30-day readmission.

The Relevance of Generalist Approaches to Early Intervention for Personality Disorder

The Relevance of Generalist Approaches to Early Intervention for Personality Disorder

Early removal of transorbital penetrating traumatic brain injury by a wooden object: a case report

Introduction and Importance: Transorbital penetrating traumatic brain injury (TPTBI) is a rare cause of penetrating head injury, yet the diagnoses can be overlooked in some cases due to incomplete history, trivial trauma, and the absence of immediate neurologic deficits. Case Presentation: A 4-year-old male child was admitted with a diagnosis of TPTBI by a wooden object. Non-contrast enhanced CT scan revealed a linear hypodense structure extending from the superior wall of the right orbit into the frontal lobe with displaced fragments into the brain. Additionally, cerebral contusion, pneumocephalus, and hematoma with surrounding edema were seen in the frontal lobe. Early extraction of the foreign body was performed by a multidisciplinary team of Neurosurgeons and Ophthalmologists. The wooden fragment of size 10 cm×1 cm×1 cm was removed by a small mini-craniotomy of the right frontal supraorbital bone with the gentle pulling of it through the dura mater and frontal cortex. The postoperative course was uncomplicated, vision was restored, and there were no neurologic deficits at the time of discharge on the 7th postoperative day with good postoperative outcomes. Clinical Discussion: Delayed removal of TPTBI may be complicated by misidentification of entry points, extensive scarring around the foreign body, adherence to the intracranial vessels, and increasing mortality due to infectious complications. Therefore, early exploration with the help of a multidisciplinary team will most likely result in successful debridement, good neurologic outcomes, and lower morbidity and mortality. Conclusion: Accurate diagnosis and early intervention for TPTBI may prevent possible infectious and neurologic complications.

Impact of early weaning and nutritional interventions on growth performance, digestive metabolism, and serum biomarkers in lambs: A biomechanical perspective

The aim of this study was to investigate the effects of early weaning and nutritional interventions on growth performance, nutrient digestion and metabolism, and serological indices of hu sheep lambs, with a view to providing a basis for the feasibility of early weaning of hu sheep lambs under conditions of supplemental milk replacer. Ninety neonatal hu sheep lambs were weaned at 21 days (n = 60) (divided into two groups: early weaned, EW; and resveratrol-fed, RSV) as well as 49 days (n = 30) (control group, CON) weaning, and the trial period was 90 days. The results showed that: 1) there was no significant difference (P &gt; 0.05) in the initial and final weights of the lambs, and the average daily gain (ADG) of the EW and RSV groups was significantly lower than that of the CON group (P &lt; 0.05) from 31 to 45 days of age. Early weaned lambs were more susceptible to weaning stress compared to late weaned lambs and the effect of nutritional intervention (feeding resveratrol) on lamb growth performance was not significant. 2) The apparent digestibility of crude protein (CP) in the experimental group was significantly lower than that of the control group (P &lt; 0.05), and the nitrogen intake, net protein utilization and protein biological value indexes of lake lambs in the experimental group were significantly different from those of the control group (P &lt; 0.05). 3) Early feeding of resveratrol was not significant in improving the digestive metabolism of nutrients. 4) Early weaning as well as the addition of resveratrol had a significant effect on the serum GLU and TC indexes of the lambs (P &lt; 0.05), but did not show a significant effect on any of the other indexes.

Long-term efficacy of mepolizumab on eosinophilic granulomatosis with polyangiitis: a retrospective study

Aim: Eosinophilic granulomatosis with polyangiitis (EGPA) is a vasculitis characterized by eosinophilic inflammation. Patients with EGPA are treated with systemic glucocorticoids and immunosuppressive drugs to induce and maintain remission. However, most patients relapse after tapering glucocorticoids, and there are refractory cases with inadequate response to glucocorticoids. Mepolizumab, a humanized anti-IL-5 antibody, is approved for relapsing or refractory EGPA. Furthermore, recent studies have reported the efficacy of benralizumab, a humanized anti-IL-5 receptor α antibody, in EGPA. Here, we investigate the efficacy of biologics on consecutive cases of EGPA. Methods: We retrospectively collected patients with EGPA treated with mepolizumab in addition to glucocorticoids at the Department of Pulmonary Medicine in Kagoshima University Hospital and Imakiire General Hospital. In this study, we compared the effects of biologics on inflammatory parameters between pre- and post-treatment of biologics in patients with EGPA. Results: Ten patients were included in the study. All patients were treated with mepolizumab, and one was switched to benralizumab later. Treatment with biologics markedly reduced EGPA relapse from 70% (pre-treatment) to 20% (post-treatment), Birmingham Vasculitis Activity Score from 8.4 to 4.0, peripheral blood eosinophil counts from 470.3 /µL to 40.5 /µL, and glucocorticoid doses from 7.3 mg/dL to 1.6 mg/dL. In contrast, lung function and fractional exhaled nitric oxide levels were not affected by treatment with biologics. Furthermore, the duration of biologics was positively correlated with symptom improvement. Conclusions: Treatment with mepolizumab for EGPA was effective in glucocorticoid sparing, symptom reduction, and relapse prevention. Mepolizumab is expected to reduce the risk of glucocorticoid-related adverse events. Therefore, continued administration as well as early intervention with mepolizumab for EGPA might be important to conserve future medical resources and control the disease.

Does child abuse predict a population segment with large economic burden?

ObjectivesThe enormous societal and individual consequences of mental health disorders and detrimental health behaviours in the general population are of paramount concern. Many argue that ‘prevention is the best cure’, pushing for the implementation of early (preventive) interventions. Key questions regarding early interventions include which population segment to target for screenings and what information these screenings should focus on. In line with previous efforts, this study aimed to identify which population segment holds the majority (≥ 80 %) of different economically costly outcomes in society, and whether child abuse before the age of 16 years predicts being part of that population segment. Study designEpidemiological cohort study. MethodsThis study used the Netherlands Mental Health Survey and Incidence Study-2, a Dutch epidemiological cohort study including 6646 adults aged 18–64 years at baseline, spanning four timepoints from 2007 to 2018. Cumulative distributions were computed to identify high-cost population segments of economically costly outcomes in adulthood (i.e., mental and physical health [behaviours], unemployment and work absenteeism). Child abuse was examined as a potential predictor of these segments and the risk of multiple high-cost population segment membership was investigated by conducting Poisson regressions. ResultsA 20 % population segment carried between 42 % and 100 % of economically costly outcomes. Being exposed to more child abuse predicted being in a high-cost population segment, albeit with small effect sizes. Being exposed to more child abuse also predicted belonging to multiple high-cost population segments across different economically costly outcomes. ConclusionsThe study findings have implications for policy makers. Emphasis should be placed on prevention aimed at identifying potential members of multiple high-cost population segments.

Nature and nurture in fussy eating from toddlerhood to early adolescence: findings from the Gemini twin cohort

BackgroundFood fussiness (FF) describes the tendency to eat a small range of foods, due to pickiness and/or reluctance to try new foods. A common behaviour during childhood, and a considerable cause of caregiver concern; its causes are poorly understood. This is the first twin study of genetic and environmental contributions to the developmental trajectory of FF from toddlerhood to early adolescence, and stability and change over time.MethodsParticipants were from Gemini, a population‐based British cohort of n = 4,804 twins born in 2007. Parents reported on FF using the Child Eating Behaviour Questionnaire ‘FF’ scale when children were 16 months (n = 3,854), 3 (n = 2,666), 5 (n = 2,098), 7 (n = 703), and 13 years old (n = 970). A mixed linear model examined the trajectory of FF, and a correlated factors twin model quantified genetic and environmental contributions to variation in and covariation between trajectory parameters. A longitudinal Cholesky twin model examined genetic and environmental influences on FF at each discrete age.ResultsWe modelled a single FF trajectory for all children, which was characterised by increases from 16 months to 7 years, followed by a slight decline from 7 to 13 years. All trajectory parameters were under strong genetic influence (&gt;70%) that was largely shared, indicated by high genetic correlations. Discrete age analyses showed that genetic influence on FF increased significantly after toddlerhood (16 months: 60%, 95% CI: 53%–67%; 3 years: 83%; 81%–86%), with continuing genetic influence as indicated by significant genetic overlap across every age. Shared environmental influences were only significant during toddlerhood. Unique environmental influences explained 15%–26% of the variance over time, with some enduring influence from 5 years onwards.ConclusionsIndividual differences in FF were largely explained by genetic factors at all ages. Fussy eating also shows a significant proportion of environmental influence, especially in toddlerhood, and may, therefore, benefit from early interventions throughout childhood. Future work needs to refine the FF trajectory and explore specific trajectory classes.

Botulinum toxin-A in acute acquired comitant esotropia during COVID pandemic in children and young adolescents

Abstract Purpose: To study the effectiveness of botulinum toxin A (BTX-A) in the treatment of patients with acute acquired comitant esotropia (AACE) due to excessive use of mobile and laptops in the COVID era in the pediatric population and adolescents. Methods: This was a retrospective, interventional study of pediatric patients and young adults who presented with AACE and received unilateral or bilateral BTX-A. All the patients complained of binocular diplopia and sudden onset of esotropia with a history of mobile or laptop usage during the COVID era (2020–2023). Twenty-seven patients with acute-onset esotropia in 3 years (2020–2023) were included. All patients were administered 2.5–7.5 units of BTX-A (Botox, Allergan, India) into the unilateral or bilateral medial rectus muscle of the deviating eye under short general anesthesia or local anesthesia. The main outcome measures were pre- and post-injection angle of deviation, pre- and post-injection stereopsis, final level of stereopsis achieved, recurrence, and whether strabismus surgery was later required. Results: The mean age of patients was 12.85 ± 7.15 years (range: 4–25 years). The mean dosage of Botox was 6 U (2.5–7.5 U). The mean follow-up was 6 months (6 months–2 years). The mean preoperative angle of deviation (AOD) was 41.11 ± 10.9 prism diopters (PD) for distance and 41.67 ± 10.9 PD for near. The maximum effect of BTX-A was seen at 1 month; post-injection AOD was 13.65 ± 14.7 PD for distance and 14.87 ± 15.8 PD for near (P &lt; 0.001). Over half of the patients achieved optimal outcomes, with improvements in stereopsis and sensory fusion. Early intervention (within 3 months of symptom onset) significantly correlated with treatment success. Conclusion: While BTX-A therapy for acute-onset esotropia demonstrates efficacy, patient-specific considerations are essential. This study highlights the evolving nature in the digital age and early administration of BTX-A along with close follow-up to monitor residual and recurrence of esotropia. The surgical intervention can increase the final success rate.

Women’s autonomy, neonatal, infant and under-five mortality in the Upper East Region of Ghana

Child mortality remains a major health challenge in Sub-Saharan Africa. Child survival is greatly influenced by household circumstances and mother’s healthcare choices. Notwithstanding tremendous investment in women empowerment in Ghana, there is limited empirical evidence on whether women’s autonomy translates into better child mortality outcomes. To examine the association between women’s autonomy and neonatal, infant and under-five mortality in the Upper East Region of Ghana. Data were obtained from a randomized cluster household survey among 15–49 years old women in seven districts in the Upper East Region. Data analysis was restricted to 3,243 women who reported ever having given birth. Based on Principal Component Analysis (PCA), we constructed an autonomy index categorized into least, moderate, and high autonomy based on responses to six questions regarding household decision-making. Bivariate and multivariate logistic regressions were used to assess the association of women’s autonomy status and mortality outcomes. Attaining secondary education or higher was significantly associated with infant mortality (adjusted odds ratio (aOR) = 0.39, CI = 0.16, 0.94) and under-five mortality (aOR = 0.39, CI = 0.18–0.87). Also, maternal age was significantly associated with neonatal, infant, and under-five mortality, while living in rural setting was significantly associated with lower risk of neonatal (aOR = 0.38, CI = 0.19–0.75) and under-five (aOR = 0.63, CI = 0.48–0.83) mortality. However, we found that compared to women with least autonomy, infants of those with moderate autonomy (aOR = 1.76, CI 1.07–2.89) and high autonomy (aOR = 1.75; CI = 1.04–2.93) were significantly more likely to die. In this study setting, women’s autonomy was not predictive of child mortality. Interventions that aim to improve child mortality should pay attention to community and family level factors that promote increase utilization of essential early childhood interventions.

Fetal hemochromatosis: rare case of hepatic and extrahepatic siderosis involving thyroid on fetal MRI

BackgroundNeonatal hemochromatosis (NH) is a rare condition that is characterized by severe neonatal liver disease in association with hepatic and extrahepatic excess iron deposition (siderosis), while sparing the reticuloendothelial system. The most common cause of fetal liver injury leading to the NH phenotype (accounting for over 95% of cases) is gestational alloimmune liver disease. This condition is caused by the transfer of maternal IgG antibodies through the placenta, targeting a fetal hepatocyte antigen. Prenatal diagnosis, particularly the identification of iron overload involving both liver and thyroid, is of significant importance and can have a profound impact on patient care. To our knowledge, no case has been reported on prenatal diagnosis of iron overload involving both liver and thyroid.Case presentationWe present an exceptionally rare case of fetal hemochromatosis in a primigravida, a case that significantly contributes to our understanding of this condition. The diagnosis was made with the presence of hepatic and extrahepatic siderosis involving the thyroid using Ultrasonography (USG) and fetal Magnetic Resonance Imaging (MRI) findings. A 23-year-old primigravida was referred to our center in view of oligohydramnios, Intrauterine Growth Restriction (IUGR) and echogenic bowel at 29 weeks of gestation. USG and fetal MRI showed features of coarse liver echotexture and iron overload involving the liver and thyroid; this is the first case describing iron accumulation in the fetal thyroid gland diagnosed in utero.ConclusionThis case underscores the critical importance of performing MRI in suspected cases of fetal hemochromatosis for early diagnosis and intervention, emphasizing the potential to significantly improve patient outcomes.

Association of child maltreatment and school bullying among Chinese adolescents: the mediating role of peer relationships

BackgroundSchool bullying, a serious problem for the physical and mental health of adolescents, is presently a significant issue in China. It is essential to recognize and comprehend potential risk factors and establish efficient preventive strategies. The purpose of this study was to examine the association between childhood maltreatment and school bullying in adolescents and to assess the mediating role of peer relationships.MethodsBetween March and April 2024, a cross-sectional survey was conducted among 2119 adolescents aged between 12 and 18 years in Guangdong Province, China. Self-report questionnaires were employed to collect data on childhood maltreatment, school bullying, and peer relationships. Subgroup analyses and mediating effects modeling were employed to analyze the data.ResultsThe results indicated that adolescents who had experienced maltreatment were more at risk of bullying victimization (OR: 2.92, 95% CI: 2.34–3.64, P < 0.001), bullying perpetration (OR: 2.84, 95% CI: 1.99–4.05, P < 0.001), and bully-victimization (OR: 2.93, 95% CI: 1.95–4.41, P < 0.001), compared to adolescents who have not. Sexual abuse showed the most significant connection with all forms of bullying. The mediating effect of peer relationships was found to mediate the association between child maltreatment and bullying behaviour. The results indicated that worse peer relationships may exacerbate the adverse effects of maltreatment experiences and increase the risk of adolescents becoming bullies, either perpetrators or victims of bullying.ConclusionsChild maltreatment has been identified as one of the most significant influences on bullying behaviour in adolescents. The quality of peer relationships has been demonstrated to play an important role in preventing and reducing the occurrence of bullying. The results underscore the crucial role of early intervention in cases of child maltreatment and the fostering of positive peer relationships in schools.

Towards a fully automatic workflow for investigating the dynamics of lung cancer cachexia during radiotherapy using cone beam computed tomography

Abstract Objective. Cachexia is a devastating condition, characterized by involuntary loss of muscle mass with or without loss of adipose tissue mass. It affects more than half of patients with lung cancer, diminishing treatment effects and increasing mortality. Cone-beam computed tomography (CBCT) images, routinely acquired during radiotherapy treatment, might contain valuable anatomical information for monitoring body composition changes associated with cachexia. For this purpose, we propose an automatic artificial intelligence (AI)-based workflow, consisting of CBCT to CT conversion, followed by segmentation of pectoralis muscles. &amp;#xD;Approach. Data from 140 stage III non-small cell lung cancer patients was used. Two deep learning models, cycle-consistent generative adversarial network (CycleGAN) and contrastive unpaired translation (CUT), were used for unpaired training of CBCT to CT conversion, to generate synthetic CT (sCT) images. The no-new U-Net (nnU-Net) model was used for automatic pectoralis muscle segmentation. To evaluate tissue segmentation performance in the absence of ground truth labels, an uncertainty metric (UM) based on Monte Carlo dropout was developed and validated. &amp;#xD;Main results. Both CycleGAN and CUT restored the Hounsfield unit fidelity of the CBCT images compared to the planning CT (pCT) images and visually reduced streaking artefacts. The nnU-Net model achieved a Dice Similarity Coefficient (DSC) of 0.93, 0.94, 0.92 for the CT, sCT and CBCT images, respectively, on an independent test set. The UM showed a high correlation with DSC with a correlation coefficient of -0.84 for the pCT dataset and -0.89 for the sCT dataset. &amp;#xD;Significance. This paper shows a proof-of-concept for automatic AI-based monitoring of the pectoralis muscle area of lung cancer patients during radiotherapy treatment based on CBCT images, which provides an unprecedented time resolution of muscle mass loss during cachexia progression. Ultimately, the proposed workflow could provide valuable information for early intervention of cachexia, ideally resulting in improved cancer treatment outcome.

A Qualitative Exploration of Refugee Experiences of Access to a Dedicated Multi-Disciplinary Refugee Health Team in an Australian Context: Implication for Future Care

Aims Refugees experience physical and mental health issues that need attention following settlement in a new community. However, access to and utilisation of healthcare services is challenging. We aimed to explore the experience of refugee access to a dedicated multi-disciplinary refugee health team. Methods An interpretative qualitative study. 17 qualitative interviews were conducted with Ezidi refugees who attended a newly established multi-disciplinary refugee health program in a regional town in NSW, Australia. Data were analysed using an inductive thematic approach. Results Participants ( n = 17) identified as Ezidi and were from Iraq. Parents were between 23 and 57 years of age and had 1–12 children per family. Most had been in Australia between 2 and 5 years. Four key themes were identified: (1) Identifying the extent of health needs following a long wait to migrate; (2) Health support across the life span: the benefit of access to a multi-disciplinary team; (3) Gaps in cultural competence – impacted by understanding and interpreter access; and (4) Ongoing health and lifestyle concerns – influenced by understanding and education. Conclusions We identified the benefit of access to allied health for prompt diagnosis, treatment and management of conditions including congenital and developmental conditions, mental health and chronic diseases. Access to a dedicated team ensured early intervention for a broad range of health and social issues including early referral to services, close coordination and help to complete supporting paperwork and applications. Ongoing investments are needed to maintain this comprehensive and coordinated approach to care that is underpinned by a family centric approach.

Management of Extra-Articular and Intra-Articular Distal Radius Malunion

This article presents a comprehensive overview of managing extra-articular and intra-articular distal radius malunions (DRM), discussing the pathoanatomy, clinical, and radiologic evaluation, conservative treatment, and surgical strategies. Corrective osteotomy remains the primary surgical intervention for symptomatic DRM. Surgical planning should consider factors such as timing, approach, correction technique, implant, graft, and associated injuries. The correction of extra-articular malunion necessitates brachioradialis tenotomy, circumferential periosteum release, and intrafocal elevation with grafting to facilitate distal radius realignment following osteotomy. Computer-assisted planning with 3D-printed patient-specific instrumentation (PSI) could help execute extra-articular osteotomy with high precision. As for the management of intra-articular malunion, it may require wrist arthrotomy, arthroscopy, or PSI assistance for precise articular osteotomy and reduction of the joint surface. This review highlights the importance of early intervention, thorough preoperative planning, and appropriate surgical techniques to optimize outcomes and minimize complications. Future research should focus on large-scale randomized controlled trials to compare different surgical methods, particularly for intra-articular DRM.