Higher Median Research Articles

Abnormal Esophageal Scintigraphy Associates With a Distinct Clinical Phenotype in Patients With Systemic Sclerosis.

In systemic sclerosis (SSc), absent contractility (AC) rather than ineffective esophageal motility on manometry is associated with a severe esophageal and extraintestinal phenotype. We sought to determine whether slow esophageal transit on scintigraphy associates with a comparable clinical phenotype to that of AC on manometry, as scintigraphy may serve as a noninvasive approach to risk-stratify patients with SSc. Clinical, demographic, and serologic features were compared between patients with and without delayed esophageal transit on scintigraphy. University of California Los Angeles Scleroderma Clinical Trials Consortium Gastrointestinal Tract (GIT) 2.0 scores measured GI symptoms, Medsger scores measured physician-assessed SSc disease severity, and the Composite Autonomic Symptom Score 31 survey evaluated dysautonomia symptoms. Of 131 patients, 79 (60%) had delayed esophageal transit by scintigraphy. Patients with delayed esophageal transit were more likely to have diffuse SSc (24 [32%] vs 11 [22%]; P = 0.024), severe lung involvement (22 [41%] vs 7 [19%]; P = 0.034), severe Raynaud (36 [47%] vs 15 [31%]; P = 0.063), and a higher median (interquartile range [IQR]) diarrhea GIT score (0.5 [IQR 0-1] vs 0 [IQR 0-1]; P = 0.050). Lower diffusing capacity of the lungs for carbon monoxide values correlated with a higher esophageal transit time (ρ = -0.32; P = 0.014). After adjusting for disease duration, delayed esophageal transit was significantly associated with severe Medsger lung scores, severe Raynaud phenomenon, and higher modified Rodnan skin scores. Patients with delayed esophageal transit by scintigraphy have a more severe SSc phenotype, similar to patients with AC, on esophageal manometry. Further studies should validate esophageal scintigraphy as a tool to identify patients with SSc with AC who may develop specific GI and extraintestinal complications.

MECOM and BAALC gene expression profiles in Egyptian patients with acute myeloid leukemia by next generation sequencing

ABSTRACT Background Acute myeloid leukemia (AML) is a challenging heterogenous hematologic malignancy characterized by suboptimal outcomes. Genetic characterization of AML enhanced the understanding of individualized patient’s risk and led to the development of new therapeutic strategies. Gene expression analysis facilitates detection of new diagnostic, prognostic, and predictive biomarkers. This necessitates the expansion of diagnostic testing with higher throughput technologies, such as targeted next-generation sequencing (NGS). Objectives To study the expression profiles of MECOM and BAALC genes in a cohort of newly diagnosed Egyptian AML patients via Oncomine Myeloid Research assay (OMA) by NGS technology in addition to studying their potential prognostic role and impact on overall survival (OS). Methods The OMA was used to evaluate the expression levels of MECOM and BAALC genes and five control genes (FBXW2, PUM1, TRIM27, PSMB2, and EIF2B1), in twenty-four newly diagnosed AML patients by NGS technology, using RNA extracted from bone marrow aspirate (BMA) specimens. Results Gene expression analysis of MECOM and BAALC genes revealed that MECOM overexpression was significantly associated with the presence of lymphadenopathy and the high MECOM median expression level was significantly associated with lower hemoglobin concentrations at presentation. BAALC overexpression showed significant associations with the presence of CD34, the presence of wild type NPM1 mutation, and the absence of FLT3-ITD mutations. However, BAALC underexpression was significantly associated with normal cytogenetics, while its overexpression was associated with adverse and favorable cytogenetics, with a statistically significant difference between them (p = 0.049)*. Statistically significant positive correlation was found between BAALC expression levels and postinduction BM blast percentages. Among these two genes, only high BAALC expression had significantly shorter OS in AML patients based on the log rank test (p = 0.037)*. Conclusion BAALC expression might be a specific molecular marker used for the assessment of prognosis and OS in AML patients and might be used in the future as targeted therapy in AML, aiming to improve patient outcomes and OS.

Forty-eight-hour cold-stored whole blood in paediatric cardiac surgery: Implications for haemostasis and blood donor exposures.

Cold-stored whole blood (CS-WB) in paediatric cardiac surgery is making a resurgence, given its identified benefits compared to conventional blood component therapy (CT). A single-centre retrospective study was conducted from January 2018 to October 2018 by including children <18 years of age undergoing cardiac surgery requiring cardiopulmonary bypass. ABO-compatible CS-WB from non-directed random donors was leukoreduced with platelet-sparing filters and compared with CT. Fifty-seven patients (30, 53% CS-WB; 27, 47% CT) were studied. Patient demographics were similar, although CT patients were cooled to a lower intra-operative temperature. Blood product requirements 24 h post operation were less in the CS-WB group (11.1 vs. 26.7 mL/kg, p = 0.048). Twelve (40%) patients in the CS-WB cohort had more than one donor exposure versus 25 (93%) in the CT group (p < 0.001). CT patients compared to CS-WB patients had a greater decrease in pre-operative versus 48-h post-operative haemoglobin, platelets and prothrombin time. Patients who received CT compared to CS-WB had a trend towards higher median (interquartile range [IQR]) chest-tube output (mL/kg/h) in the first 4 h post cardiac intensive care unit (ICU) admission (2.1 [0.8, 3] vs. 1.6 [0.8, 2.2], p = 0.197). There was no difference in antifibrinolytic use, length of stay, sepsis, acute kidney injury or wound infection. Survival to discharge was similar. CS-WB in paediatric cardiac surgery may reduce donor exposure and improve haemostatic balance. Future multi-centre prospective studies are needed to validate these findings and identify patients who would benefit from CS-WB in paediatric cardiac surgery.

Clinical and splenectomy-based treatment outcomes in 40 cases of hepatosplenic T-cell lymphoma: a comprehensive analysis

Background/aimThis research study was conducted to examine the clinical characteristics and post-splenectomy survival outcomes of patients diagnosed with hepatosplenic T-cell lymphoma (HSTCL).Materials and methodsA total of 10 cases of HSTCL patients admitted to the Hematology Department of Fudan University Affiliated Huadong Hospital between January 2012 and December 2021 were included. In addition, we also included 30 other cases reported from domestic and international sources. All pathological specimens were stained with hematoxylin and eosin (H&E) and immunohistochemistry, with color development using DAB staining. Survival analysis was conducted using Kaplan-Meier curves and log-rank tests.ResultsIn the 10 HSTCL patients, Epstein-Barr virus (EBV) infection was confirmed. Six patients had died, with 5 of them within 1 year of disease onset. Survival analysis showed poorer prognosis in patients with hemophagocytic syndrome and thrombocytopenia. Patients who underwent splenectomy followed by chemotherapy had a higher median and average survival time compared to those who only received chemotherapy. The study included a total of 40 HSTCL patients, with 29 males and 11 females, and an average age of onset at 42.3 years. All patients presented with fever, with some exhibiting emaciation and/or hemophagocytic syndrome. Splenomegaly, hepatomegaly, lymphadenopathy, and bone marrow involvement were found in the patients. Common laboratory findings included leukopenia, anemia, and thrombocytopenia. All patients exhibited elevated ferritin levels and decreased blood calcium levels.ConclusionThose patients suffering from hemophagocytic syndrome at the onset of this disease face greater treatment-related difficulties and a higher risk of mortality. Combined chemotherapy after splenectomy may improve HSTCL patient survival.

Trends of trauma team physicians toward patients with bleeding in Saudi Arabia: a cross-sectional study

ABSTRACT Objectives Trauma poses a significant health burden in Saudi Arabia, with high rates of morbidity and mortality rates. We evaluated the trends among trauma team (TT) physicians in Saudi Arabia regarding their awareness and referral practices for percutaneous endovascular arterial embolization (EAE) in bleeding patients. Methods A 13-question survey developed by consultants from various specialties assessed the knowledge of TT physicians regarding decision-making and appropriate approaches for managing traumatic bleeding. The surveys were administered in person to 135 TT physicians. Results Among them, 38.52% had five or more years of independent practice, and 87.41% routinely encountered patients with bleeding patients. Physicians who routinely treated patients with bleeding patients exhibited higher median scores, in line with current management standards (p = 0.634). Tertiary care physicians and academic- and military-affiliated physicians exhibited higher median scores (p = <0.001 and p < 0.006, respectively). Amongst TT physicians, 47.41% preferred EAE for unstable pelvic ring fractures with active bleeding, while 68.15% favored splenectomy for unstable patients with grade V splenic injuries. For traumatic aortic injuries, 67.42% considered TEVAR/EVAR safer options. Notably, 84.44% viewed an INR > 3 as a contraindication for EAE in hemodynamically stable patients. General surgeons scored the highest in management decision-making, followed by neurosurgeons (p = 0.001). Orthopedics, emergency medicine, intensive care (ICU), and anesthesia specialists exhibited similarly high median scores for appropriate management approaches (p = 0.003). Overall, general surgeons, orthopedic surgeons, and ICU specialists exhibited the highest median correct responses, adhering to the current standard of practice (p = 0.001). Conclusions To address the potentially life-threatening condition of traumatic bleeding, raising awareness of the appropriate management and referral patterns for EAE is crucial.

Agent-Based Model of Combined Community- and Jail-Based Take-Home Naloxone Distribution

Opioid-related overdose accounts for almost 80 000 deaths annually across the US. People who use drugs leaving jails are at particularly high risk for opioid-related overdose and may benefit from take-home naloxone (THN) distribution. To estimate the population impact of THN distribution at jail release to reverse opioid-related overdose among people with opioid use disorders. This study developed the agent-based Justice-Community Circulation Model (JCCM) to model a synthetic population of individuals with and without a history of opioid use. Epidemiological data from 2014 to 2020 for Cook County, Illinois, were used to identify parameters pertinent to the synthetic population. Twenty-seven experimental scenarios were examined to capture diverse strategies of THN distribution and use. Sensitivity analysis was performed to identify critical mediating and moderating variables associated with population impact and a proxy metric for cost-effectiveness (ie, the direct costs of THN kits distributed per death averted). Data were analyzed between February 2022 and March 2024. Modeled interventions included 3 THN distribution channels: community facilities and practitioners; jail, at release; and social network or peers of persons released from jail. The primary outcome was the percentage of opioid-related overdose deaths averted with THN in the modeled population relative to a baseline scenario with no intervention. Take-home naloxone distribution at jail release had the highest median (IQR) percentage of averted deaths at 11.70% (6.57%-15.75%). The probability of bystander presence at an opioid overdose showed the greatest proportional contribution (27.15%) to the variance in deaths averted in persons released from jail. The estimated costs of distributed THN kits were less than $15 000 per averted death in all 27 scenarios. This study found that THN distribution at jail release is an economical and feasible approach to substantially reducing opioid-related overdose mortality. Training and preparation of proficient and willing bystanders are central factors in reaching the full potential of this intervention.

Mortality Among Severely Injured Adolescents Admitted to Pediatric vs Adult Trauma Centers

Care in a pediatric (vs adult) trauma center improves outcomes for injured children aged 0 to 12 years, but whether pediatric care benefits injured adolescents is unclear. To evaluate the association of pediatric vs adult trauma center care with mortality among severely injured adolescents. This retrospective cohort study was conducted between April 1, 2012, and March 31, 2020, among adolescents aged 12 to 16 years who were admitted to level I or level II adult trauma centers or a level I pediatric trauma center in British Columbia, Canada. Analysis was conducted between January and September 2024. Admission to a level I pediatric trauma center or level I or level II adult trauma center. The primary outcome was hospital mortality for the index trauma incident. Inverse probability of treatment weighting was used to estimate the association of admission to a pediatric trauma center with mortality. A total of 416 patients aged 12 to 16 years (median [IQR] age, 15 [13-16] years; 308 male [74.0%]) were admitted to a level I or level II trauma center with severe injury (201 [48.6%] at a pediatric trauma center; 83 [20.0%] at a level I adult trauma center; and 132 [31.7%] at a level II adult trauma center). Patients admitted to the pediatric trauma center (vs level I or level II adult centers) had lower median (IQR) age (14 [13-15] years vs 15 [14-16] years), higher median (IQR) Injury Severity Score (16 [9-21] vs 13 [9-18]) and fewer penetrating injuries (10 injuries [5.0%] vs 28 injuries [13.0%]). Hospital mortality was 7.0% (14 of 201 patients) among patients admitted to the pediatric center vs 4.2% (9 of 215 patients) among those admitted to an adult trauma center. There was no statistically significant difference in hospital mortality between patients admitted to pediatric vs adult trauma centers (adjusted odds ratio, 2.61; 95% CI, 0.88-7.69; P = .08). In this cohort study of severely injured adolescents, pediatric trauma center admission was not associated with improved hospital mortality. These findings suggest that severely injured adolescents aged 12 to 16 years may be safely treated at either adult or pediatric trauma centers.

BIOM-44.18F-DOPA-PET THRESHOLDS FOR BOTH NEWLY DIAGNOSED AND RECURRENT ASTROCYTOMA USING PATHOLOGICAL GROUPING OF SPATIALLY CORRELATED BIOPSIES

Abstract BACKGROUND Glioma radiotherapy planning requires accurate tumor delineation. While T1- contrast-enhanced-MRI (T1-CE-MRI) is the standard, due to blood-brain-barrier breakdown dependencies, T1-CE-MRI fails to reflect the extent of glioma. Studies using amino acid PET tracers report glioma uptake up to 3cm-4cm beyond T1-CE. In this study, amino acid tracer 18F-fluoro-dihydroxyphenylalanine (18F-DOPA) uptake was correlated with histopathological features to determine tumor thresholds. METHODS Using registered 18F-DOPA-PET and T1-CE-MRI images in the Stealth Neuronavigation system targeting concordant and discordant regions, 181 stereotactic biopsy samples (newly-diagnosed=74; recurrent=107) were obtained from 59 enrolled astrocytoma patients across two prospective phase II clinical trials between 2010-2019. An experienced neuropathologist reviewed each sample with hematoxylin and eosin stain and assigned an alphanumeric score: mitotic activity (0=no tumor; 1=no mitosis; 2=few/scattered mitosis; 3=frequent mitosis) and cellular density (A=&amp;lt;25%; B=25%-50%; C=50%-75%; D=&amp;gt;75%). Samples assigned 1C-1D, 2B-2D, or 3A-3D were categorized as histopathological high-score (aggressive disease), remaining samples as low-score. Relative mean (rFDOPA_mean) tumor-to-background uptake ratios were computed for 5mm uniformly expanded volumes from each Stealth biopsy coordinate using the crescent and wedge normalization methods. Relative uptake was compared overall and separately within newly-diagnosed/recurrent disease subgroups. An optimal rFDOPA_mean threshold to delineate high- from low-score was determined using the maximal Youden index of ROC curves. RESULTS Overall, high-score samples (n=116) had higher median (IQR) rFDOPA_mean uptake than low-score samples (n=65): high-score rFDOPA:mean=1.70(1.16-2.26), low-score rFDOPA:mean=1.16(0.83-1.49), Kruskal-Wallis p&amp;lt;0.001. The uptake difference between high- vs. low-score samples was observed within newly-diagnosed and recurrent subgroups, but was only significant for newly-diagnosed (p&amp;lt;0.001). For newly-diagnosed, an rFDOPA:mean=1.49 cutoff between high- and low-score groups shows 69% accuracy, 63% sensitivity, 80% specificity (AUC=0.782). Using the wedge normalization method, rFDOPA_mean values were 0.2 higher than crescent method values. CONCLUSIONS This work presents histologically verified 18F-DOPA-PET thresholds for aggressive disease in newly-diagnosed astrocytoma patients. Separate thresholds will need to be determined for recurrent glioma patients.

Skin Cancer Awareness, Beliefs, Behaviors, and Access to Care Among the Homeless and Underinsured Patients Using a Free Clinic in Nebraska.

To understand the attitudes, beliefs, knowledge, and access to care surrounding sun safety for a primarily homeless or underinsured patient population at a student-run health clinic. All adult attendees at the health clinicwere invited to completean anonymous 16-item questionnaire that assessed their sun safety history, practices, knowledge, and beliefs. Fifty participants completed our questionnaire, with 35 individuals (70%) reporting that they were without permanent residence, and 21 individuals indicating that they were uninsured or using Medicaid (42%). The typical reported daily sun exposure was high (median=4 hours), while sunscreen use was uncommon (mean=1.83, falling between a "Never" or "Rarely" rating). Only 10 participants (20%) reported having ever seen a dermatologist though commonly assumed barriers such as transportation, cost, or wait time were not endorsed at high rates. Conclusion: Our findings highlight areas for targeted education surrounding sun safety and identify sun protection methods accessible for this patient population.

Dyssynchronous Fetal Heart Failure in Maternal Diabetes: Evaluation with Speckle Tracking Echocardiography and Novel M-Mode Software

ObjectivesThis study aimed to investigate dyssynchronous heart failure in fetuses of mothers with diabetes mellitus (FDM) and fetal controls (FC) using two-dimensional speckle tracking echocardiography (2D-STE) and novel M-mode prototype software (PS). MethodsIn this cohort study 174 fetuses were analyzed, 87 in the FDM-cohort and 87 gestational age-matched fetuses in the FC-cohort. A subgroup of 38 fetuses formed the final case group, with a high median frame rate of approximately 160 frames/s. Using 2D Cardiac Performance Analysis software (TOMTEC, Unterschleissheim, Germany) we measured global longitudinal strain (GLS). TOMTEC PS detected annular displacement by assessing an artificial M-mode on the previously generated tracking. Dyssynchrony (DYS) was calculated as the inter- and intraventricular difference in time to peak GLS or annular displacement. ResultsGreater DYS was observed in all basal myocardial measurement sites and software between FDM-cohort compared to FC-cohort and no significant correlation was found between DYS measurements and gestational age. Intraventricular DYS between the basal segments was statistically significant (all p ≤ 0.036, Wald test of univariate regression models). The PS performed best in DYS measurements identifying right ventricular DYS as potentially predicting FDM (FDM: median, 18.5 (interquartile range [IQR], 13.9–25.0) ms vs. FC: median, 2.7 [IQR, 1.5–3.5] ms; p < 0.001). ConclusionIncreased intraventricular DYS demonstrated an impact of maternal diabetes mellitus on fetal hearts independent of gestational age. The prototype M-mode method identified cardiac dysfunction with higher accuracy than the conventional analysis. High-quality echocardiographic image acquisition is imperative for clinical application of 2D-STE and related advanced technologies.

HOXA9 and CD163 potentiate pancreatic ductal adenocarcinoma progression

BackgroundThe role of HOXA9 requires investigations in pancreatic ductal adenocarcinoma (PDAC) as HOXA9 inhibitors are being developed. HOXA9 might attract CD163 expressed tumor associated macrophages (TAM) and could affect PDAC prognosis. This work aims to study the expression and relevance of HOXA9 and CD163 in PDAC progression.Materials and methodsSelected 98 PDAC and 98 adjacent non tumor tissues as a control group were immunostained with HOXA9 and CD163 antibodies.ResultsPDAC displayed highly significant higher HOXA9 staining intensity, percent and H score values than control group. HOXA9 staining of PDAC cases showed significant associations with poor prognostic indicators including larger tumor size, higher grade and advanced stage. PDAC showed highly significant differences regarding CD163 macrophage-specific staining intensity, percent and H score values than control group. CD163 showed significant higher expressions with larger tumor size, higher histological grade and advanced stage group. HOXA9 staining in PDAC showed highly significant direct correlations with CD163 positive macrophages. Follow up of PDAC cases revealed that high median H score of HOXA9 and CD163 were significantly associated with worse overall survival. CD163 was an independent prognostic marker of worse survival.ConclusionsIn conclusion, HOXA9 could potentiate PDAC progression by stimulating CD163 expressed TAM attraction in tumors. HOXA9 and CD163 could participate in PDAC therapy. HOXA9 and CD163 could be predictors of worse prognosis and shorter survival in PDAC.

The mass profiles of dwarf galaxies from Dark Energy Survey lensing

ABSTRACT We present a novel approach to extracting dwarf galaxies from photometric data to measure their average halo mass profile with weak lensing. We characterize their stellar mass and redshift distributions with a spectroscopic calibration sample. By combining the ${\sim} 5000\,\mathrm{deg}^2$ multiband photometry from the Dark Energy Survey and redshifts from the Satellites Around Galactic Analogs Survey with an unsupervised machine learning method, we select a low-mass galaxy sample spanning redshifts $z\lt 0.3$ and divide it into three mass bins. From low to high median mass, the bins contain [146 420, 330 146, 275 028] galaxies and have median stellar masses of $\log _{10}(M_*/\text{M}_\odot)=\left[8.52\substack{+0.57 -0.76},\, 9.02\substack{+0.50 -0.64},\, 9.49\substack{+0.50 -0.58}\right]$ . We measure the stacked excess surface mass density profiles, $\Delta \Sigma (R)$, of these galaxies using galaxy–galaxy lensing with a signal-to-noise ratio of [14, 23, 28]. Through a simulation-based forward-modelling approach, we fit the measurements to constrain the stellar-to-halo mass relation and find the median halo mass of these samples to be $\log _{10}(M_{\rm halo}/\text{M}_\odot)$ = [$10.67\substack{+0.2 -0.4}$, $11.01\substack{+0.14 -0.27}$, $11.40\substack{+0.08 -0.15}$]. The cold dark matter profiles are consistent with NFW (Navarro, Frenk, and White) profiles over scales ${\lesssim} 0.15 \, {h}^{-1}$ Mpc. We find that ${\sim} 20$ per cent of the dwarf galaxy sample are satellites. This is the first measurement of the halo profiles and masses of such a comprehensive, low-mass galaxy sample. The techniques presented here pave the way for extracting and analysing even lower mass dwarf galaxies and for more finely splitting galaxies by their properties with future photometric and spectroscopic survey data.

Transcutaneous carbon dioxide monitoring in children undergoing rigid bronchoscopy: a prospective blinded observational study.

Anesthetic management during rigid bronchoscopy in children can be challenging, and continuous end-tidal carbon dioxide (EtCO2) monitoring is often unachievable. Transcutaneous carbon dioxide (TcCO2) monitoring is strongly correlated with the partial pressure of carbon dioxide (PaCO2) and EtCO2. We aimed to investigate the incidence of hypercapnia in children undergoing rigid bronchoscopy. We enrolled patients aged < 18yr scheduled for rigid bronchoscopy in a prospective observational study. We recorded TcCO2 values from anesthesia induction to the postanesthesia care unit (PACU) stay. We ended monitoring when TcCO2 reached values ≤ 50mm Hg. The operating room (OR) team was blinded to the TcCO2. The outcome of primary interest was the incidence of hypercapnia (TcCO2 > 50mm Hg) in the OR. Other outcomes were the incidences of hypercapnia in the PACU and severe hypercapnia (TcCO2 > 90mm Hg), factors possibly related to hypercapnia (patient, surgery, or anesthesia factors), and the incidence of perioperative adverse events. A total of 30 patients were enrolled. The median [interquartile range (IQR)] age was 3.5 [1.5-8.0] yr. The incidence of hypercapnia was 100% in the OR and 60% in the PACU. Five cases (17%) presented with severe hypercapnia in the OR. The highest median [IQR] TcCO2 was 69 [61-79] mm Hg. The most common adverse event was oxygen desaturation (57%, 17/30). Patients with severe hypercapnia had long stays in the PACU. Hypercapnia was a frequent event in children undergoing rigid bronchoscopy and severe hypercapnia was associated with a long PACU stay. Further studies are needed to assess the utility of TcCO2 monitoring in guiding ventilatory interventions during these cases.

Current exposure to environmental pollutants in the general adult population of Kinshasa, Democratic Republic of Congo (DRC): A cross-sectional study

BackgroundEnvironmental pollution is a serious public health problem because of its adverse effects on both human health and biodiversity. In Western countries, many human biomonitoring (HBM) studies are conducted to assess population exposure to pollutants. In contrast, the number of HBM studies in Africa is very low. ObjectiveTo measure contamination by arsenic, lead, 4,4′-dichlorodiphenyldichloroethylene (4,4′-DDE) and polychlorobiphenyls (PCBs) in the adult population of Kinshasa and to identify the susceptible population. MethodsIn the present work, we measured the contamination by arsenic in urine and lead in blood and by 4,4′-DDE and polychlorobiphenyls (PCBs) in serum in samples collected from 151 volunteers recruited in Kinshasa, the capital of the Democratic Republic of Congo (DRC). ResultsThe PCBs 180, -153 and −138 were detected in most samples with median concentrations of 0.04, 0.05 and 0.04 ng/ml, respectively. The median concentration of 4,4′-DDE was 0.83 ng/ml and 12.7% of our population showed contamination above the threshold of 3.675 ng/ml, which is associated with a significantly higher risk of cancer. Arsenic concentrations were also high (median: 48.1 μg/L in urine). Finally, exposure to lead is problematic: the median blood concentration was 54.9 μg/L, which is above the thresholds proposed by the WHO and the US CDC (50 μg/L and 35 μg/L respectively) to initiate clinical intervention, and 12.6% of the population had a lead level above 100 μg/L, which is associated with several health outcomes. ConclusionsOur results highlight the need for further HBM studies in Africa and should encourage the authorities of the DRC to implement laws and regulations to reduce pollution and population exposure.

Comparison of intramuscular medetomidine versus medetomidine–vatinoxan sedation in bearded dragons (Pogonavitticeps)

ObjectiveTo assess sedation following intramuscular (IM) administration of medetomidine versus medetomidine–vatinoxan in bearded dragons. Study designProspective, randomized, experimental, crossover study. AnimalsA group of 10 (five males and five females) bearded dragons (mean mass ± standard deviation 172 ± 28 g). MethodsAll animals were administered both medetomidine (0.2 mg kg–1) (MED) and medetomidine (0.2 mg kg–1)–vatinoxan (4 mg kg–1) (MED-VAT) IM, with a 14–16 day washout period between treatments. Sedation was assessed using an adapted version of a sedation scale for bearded dragons (scale range 0–12) before (T0), and every 5 minutes from 10 to 45 minutes after treatment administration (T10–T45). Sedation scores were compared: 1) between time points (within treatments) using a Friedman test and Dunn’s post hoc test; and 2) between treatments at each time point using a Wilcoxon paired test. Heart rate and respiratory rate (fR) were analyzed descriptively. At T45, atipamezole was administered IM. ResultsCompared with T0, sedation scores were significantly higher at most time points for both treatments. Highest median (range) scores occurred at T30 for MED [T0, 0 (0–0); T30, 2.5 (1–5); p = 0.0001] and at T35 and T40 for MED-VAT [T0, 0 (0–0); T35, 2 (1–5); p = 0.002; T40, 2 (1–5); p = 0.001]. No significant differences in sedation scores were identified between treatments at any time point. The two protocols caused bradycardia and reduction in fR. All animals were active and ate 1 hour after reversal administration. Conclusions and clinical relevanceBoth medetomidine and medetomidine–vatinoxan caused similar mild sedation in bearded dragons (median < 3/12). Inclusion of vatinoxan did not enhance sedation in this species.

Transpulmonary Pressure-Guided Mechanical Ventilation in Severe Acute Respiratory Distress Syndrome in PICU: Single-Center Retrospective Study in North India, 2018–2021

Objectives: In this study, we have reviewed the association between esophageal pressure-guided positive end-expiratory pressure (PEEP) setting and oxygenation and lung mechanics with a conventional mechanical ventilation (MV) strategy in patient with moderate to severe pediatric acute respiratory distress syndrome (PARDS). Design: Retrospective cohort, 2018–2021. Setting: Tertiary PICU. Patients: Moderate to severe PARDS patients who required MV with PEEP of greater than or equal to 8 cm H2O. Interventions: Esophageal pressure (i.e., transpulmonary pressure [PTP]) guided MV vs. not. Measurements and Main Results: We identified 26 PARDS cases who were divided into those who had been managed with PTP-guided MV (PTP group) and those managed with conventional ventilation strategy (non-PTP). Oxygenation and lung mechanics were compared between groups at baseline (0 hr) and 24, 48, and 72 hours of MV. There were 13 patients in each group in the first 24 hours. At 48 and 72 hours, there were 11 in PTP group and 12 in non-PTP group. On comparing these groups, first, use of PTP monitoring was associated with higher median (interquartile range) mean airway pressure at 24 hours (18 hr [18–20 hr] vs. 15 hr [13–18 hr]; p = 0.01) and 48 hours (19 hr [17–19 hr] vs. 15 hr [13–17 hr]; p = 0.01). Second, use of PTP was associated with higher PEEP at 24, 48, and 72 hours (all p &lt; 0.05). Third, use of PTP was associated with lower Fio 2 and greater Pao 2 to Fio 2 ratio at 72 hours. Last, there were 18 of 26 survivors, and we failed to identify an association between use of PTP monitoring and survival. Conclusions: In this cohort of moderate to severe PARDS cases undergoing MV with PEEP greater than or equal to 8 cm H2O, we have identified some favorable associations of oxygenation status when PTP-guided MV was used vs. not. Larger studies are required.

Whole blood to total transfusion volume ratio in injured children: A national database analysis.

Whole blood (WB) resuscitation is increasingly common in adult trauma centers and some pediatric trauma centers, as studies have noted its safety and potential superiority to component therapy (CT). Previous analyses have evaluated WB as a binary variable (any versus none), and little is known regarding the "dose response" of WB in relation to total transfusion volume (TTV) (WB/TTV ratio). Injured children younger than 18 years who received any blood transfusion within 4 hours of hospital arrival across 456 US trauma centers were included from the American College of Surgeons Trauma Quality Improvement Program database. The primary outcome was 24-hour mortality, and the secondary outcome was 4-hour mortality. Multivariate analysis was used to evaluate associations between WB administration and mortality and WB/TTV ratio and mortality. Of 4,323 pediatric patients included in final analysis, 88% (3,786) received CT only, and 12% (537) received WB with or without CT. Compared with the CT group, WB recipients were more likely to be in shock, according to pediatric age-adjusted shock index (71% vs. 60%) and had higher median (interquartile range) Injury Severity Score (26 [17-35] vs. 25 [16-24], p = 0.007). Any WB transfusion was associated with 42% decreased odds of mortality at 4 hours (adjusted odds ratio [aOR], 0.58 [95% confidence interval, 0.35-0.97]; p = 0.038) and 54% decreased odds of mortality at 24 hours (aOR, 0.46 [0.33-0.66]; p < 0.001). Each 10% increase in WB/TTV ratio was associated with a 9% decrease in 24-hour mortality (aOR, 0.91 [0.85-0.97]; p = 0.006). Subgroup analyses for age younger than 14 years and receipt of massive transfusion (>40 mL/kg) also showed statistically significant survival benefit for 24-hour mortality. In this retrospective American College of Surgeons Trauma Quality Improvement Program analysis, use of WB was independently associated with reduced 24-hour mortality in children; further, higher proportions of WB used over the total resuscitation (WB/TTV ratio) were associated with a stepwise increase in survival. Prognostic and Epidemiological; Level III.

Invasive ventilation at the boundary of viability: A respiratory pathophysiology study of infants born between 22 and 24 weeks of gestation

BackgroundInvasive ventilation of infants born before 24 weeks of gestation is critical for survival and long-term respiratory outcomes, but currently there is a lack of evidence to guide respiratory management. We aimed to compare respiratory mechanics and gas exchange in ventilated extremely preterm infants born before and after 24 weeks of gestation. MethodsSecondary analysis of two prospective observational cohort studies, comparing respiratory mechanics and indices of gas exchange in ventilated infants born at 22–24 weeks of gestation (N=14) compared to infants born at 25–27 weeks (N=37). The ventilation/perfusion ratio (VA/Q), intrapulmonary shunt, alveolar dead space (VDalv) and adjusted alveolar surface area (SA) were measured in infants born at the Neonatal Unit of King’s College Hospital NHS Foundation Trust, London, UK. ResultsCompared to infants of 25–27 weeks, infants of 22–24 weeks had higher median (IQR) intrapulmonary shunt [18 (4 - 29) % vs 8 (2 – 12) %, p=0.044] and higher VDalv [0.9 (0.6 – 1.4) vs 0.6 (0.5 – 0.7) ml/kg, p=0.036], but did not differ in VA/Q. Compared to infants of 25–27 weeks, the infants of 22–24 weeks had a lower adjusted SA [509 (322- 687) vs 706 (564 - 800) cm2, p=0.044]. The infants in the two groups did not differ in any of the indices of respiratory mechanics. ConclusionVentilated infants born before 24 completed weeks of gestation exhibit abnormal gas exchange, with higher alveolar dead space and intrapulmonary shunt and a decreased alveolar surface area compared to extreme preterms born after 24 weeks of gestation.

Hypertrophy Determination of H9c2 Cardiomyoblast Cell Line Using Wright-Giemsa Staining: An Experience in Developing an Acceptable and Easy-to-handle In-vitro Protocol

Introduction Cell-size area (CSA) becomes the standard parameter routinely tested in vitro for cardiac hypertrophy studies. Thus, staining is an essential tool for this purpose. As reported in a previous study, immunofluorescence staining is an established method for CSA. However, because it is expensive and requires a specialized microscope, e.g., immunofluorescence or confocal microscope, it is not applicable in a laboratory with limited equipment. Wright-Giemsa staining is a standard procedure in hematology laboratories and is inexpensive and convenient. Here, we shared our experience developing a CSA determination protocol using Wright-Giemsa in H9c2 cardiomyoblast. Methods The viability tests were performed on H9c2 to determine the effective dosage of angiotensin II and Irbesartan (standard drug). The H9c2 were divided into three groups: the control group (without either angiotensin II or irbesartan), the negative control (with angiotensin II), and the positive control (with angiotensin II and Irbesartan), triplicate for each group. The cells then are acclimatized overnight, serum-starved for one day, and incubated with angiotensin and irbesartan for 48 hours. Lastly, Wright-Giemsa was observed using a light microscope in three fields. The CSA was determined by three independent observers blindly, statistically different if the p&lt;0.05 using ANOVA ways or Kruskal-Wallis. Results After the H9c2 induced by angiotensin-II 1 μM and Irbesartan 1μM, we found the CSA significantly differed among each group (p&lt;0,0001). The negative control has a higher median and interquartile range (IQR) CSA (10.78 (6.79) um2) compared to the control group (median (IQR) 7.27 (4.91) um2) and positive control (median (IQR) 7.849(5.31) um2). Conclusion It can be concluded that the Wright-Giemsa might help determine the CSA for in-vitro hypertrophic studies.

Early Dysglycemia Is Detectable Using Continuous Glucose Monitoring in Very Young Children at Risk of Type 1 Diabetes.

Continuous glucose monitoring (CGM) can detect early dysglycemia in older children and adults with presymptomatic type 1 diabetes (T1D) and predict risk of progression to clinical onset. However, CGM data for very young children at greatest risk of disease progression are lacking. This study aimed to investigate the use of CGM data measured in children being longitudinally observed in the Australian Environmental Determinants of Islet Autoimmunity (ENDIA) study from birth to age 10 years. Between January 2021 and June 2023, 31 ENDIA children with persistent multiple islet autoimmunity (PM Ab+) and 24 age-matched control children underwent CGM assessment alongside standard clinical monitoring. The CGM metrics of glucose SD (SDSGL), coefficient of variation (CEV), mean sensor glucose (SGL), and percentage of time >7.8 mmol/L (>140 mg/dL) were determined and examined for between-group differences. The mean (SD) ages of PM Ab+ and Ab- children were 4.4 (1.8) and 4.7 (1.9) years, respectively. Eighty-six percent of eligible PM Ab+ children consented to CGM wear, achieving a median (quartile 1 [Q1], Q3) sensor wear period of 12.5 (9.0, 15.0) days. PM Ab+ children had higher median (Q1, Q3) SDSGL (1.1 [0.9, 1.3] vs. 0.9 [0.8, 1.0] mmol/L; P < 0.001) and CEV (17.3% [16.0, 20.9] vs. 14.7% [12.9, 16.6]; P < 0.001). Percentage of time >7.8 mmol/L was greater in PM Ab+ children (median [Q1, Q3] 8.0% [4.4, 13.0] compared with 3.3% [1.4, 5.3] in Ab- children; P = 0.005). Mean SGL did not differ significantly between groups (P = 0.10). CGM is feasible and well tolerated in very young children at risk of T1D. Very young PM Ab+ children have increased SDSGL, CEV, and percentage of time >7.8 mmol/L, consistent with prior studies involving older participants.