Inadequate Sampling Research Articles

OGC O04 - The role of capsule-sponge technology in Barrett's surveillance: A two-year experience

Abstract Background Barrett's surveillance requires regular endoscopic and histological assessment of the oesophagus to reduce the risk of progression to oesophageal cancer. Capsule-sponge technology has been used in the assessment of reflux for some years, and is increasingly used as an adjunct or replacement for endoscopic surveillance of Barrett's. Current NICE guidance does not advocate complete replacement of surveillance with capsule-sponge assessment but notes the potential benefits of the technology and highlights the requirement for more evidence and research. This study aimed to describe two-year experience with capsule-sponge technology in the surveillance of Barrett's Oesophagus. Method All patients who were due for Barrett's surveillance from September 2022 to June 2024 were screened to see if they were appropriate for capsule-sponge assessment. Appropriate patients were approached and offered capsule-sponge assessment. Patients who were not appropriate, or declined, were offered standard endoscopic surveillance. Capsule sponge assessment was performed using the CytospongeTM and sponges sent to Cyted for cytological analysis. All patients were entered onto a prospectively maintained database and monitored for progression of symptoms or development of gastro-oesophageal cancer. Cost implications, clinical outcomes and impact on endoscopy resource utilisation were measured. Results 379 patients had Cytosponge assessment for Barrett's oesophagus. 34 (9%) required endoscopy for either an abnormal cytology or an inadequate sample. Cytosponge assessment picked up many pathologies including high-grade dysplasia, oesophageal carcinoma and ulceration or atypia. All patients who had a Cytosponge have been booked for endoscopy for their next Barrett's assessment (in keeping with current guidelines); none have presented with inter-test malignancy. Over the same time period, three patients have presented with oesophageal cancer who have only had endoscopic assessment. Utilisation of capsule-sponge technology has saved almost 350 endoscopies (700 points) over 21 months, or over 70 endoscopy lists. Conclusion Utilisation of capsule-sponge assessment for Barrett's oesophagus is safe and effective and can have a rapid and sustainable effect on reducing demand on endoscopy lists. The procedure is better tolerated than endoscopy, reproducible and may be a more accurate method of Barrett's surveillance than endoscopy alone.

Establishing a Collaborative Genomic Repository for Adult Burn Survivors: A Burn Model System Feasibility Study

In this study, we aimed to integrate a genetic repository with an existing longitudinal national burn database. We set out two primary objectives, namely (1) to develop standard operating procedures for genetic sample collection and storage, DNA isolation, and data integration into an existing multicenter database; and (2) to demonstrate the feasibility of correlating genetic variation to functional outcomes in a pilot study, using the catechol-O-methyltransferase (COMT) gene. Dubbed the worrier/warrior gene, COMT variants have been associated with varying phenotypes of post-traumatic stress, wellbeing, and resilience. Between August 2018 and July 2020, COMT variants were identified for 111 participants from three sites and correlated with their outcome data. We found no association between COMT variants and functional outcomes, likely due to the inadequate sample size. We also asked all potential participants why they consented to or refused genetic analysis. A thematic analysis of responses revealed altruism and personal interest/enthusiasm in the study as top reasons for consenting. Privacy concerns were the most common reason for refusal. In conclusion, we successfully developed standard operating procedures for genetic sample collection and storage, DNA isolation, and data integration into an existing database, and we demonstrated the feasibility of conducting a multicenter collaborative study using a centralized lab location.

To ride-hail or not to ride-hail? Complementarity and competition between public transit and transportation network companies through the lens of app data

AbstractTransportation Network Company (TNC) services have become a prominent factor in urban transportation in recent years, and there is an ongoing debate regarding their relationship with public transit. While many argue that TNCs draw passengers away from public transportation, others believe the two modes complement each other. However, due to the inadequate sample size of rider surveys as primary data sources, our understanding of how riders choose between these two modalities remains limited. This study uses nine months of trip planning data generated by the Transit App, which captures how travelers engage with multiple options in real time, including TNC and public transit services. We extract measures from Transit describing the travel options and the habits of each individual user for sessions in which the user “tapped” on one of these two modes, indicating consideration of it as an option. Machine learning models predict the likelihood of a rider tapping TNC based on features of the available public transit options and other contextual factors (e.g., time of day, weather conditions). The models find that these taps are driven by factors that highlight the convenience of TNC, such as the waiting time, walking distance, and the number of transfers for public transportation trips. We also find that the majority of TNC trips tapped by app users combine the two modes when using the Transit App, with TNC acting as a connection to or from public transit. These results provide detailed additional evidence for current arguments for both competition and complementarity between TNC and public transit from a population that uses an app to navigate public transit.

Using eDNA to Supplement Population Genetic Analyses for Cryptic Marine Species: Identifying Population Boundaries for Alaska Harbour Porpoises.

Isolation by distance and biogeographical boundaries define patterns of population genetic structure for harbour porpoise along the Pacific coast from California to British Columbia. Until recently, inadequate sample sizes in many regions constrained efforts to characterise population genetic structure throughout the coastal waters of Alaska. Here, tissue samples from beachcast strandings and fisheries bycatch were supplemented with targeted environmental DNA (eDNA) samples in key regions of Alaska coastal and inland waters. Using a geographically explicit, hierarchical approach, we examined the genetic structure of Alaska harbour porpoises, using both mitochondrial DNA (mtDNA) sequence data and multilocus SNP genotypes. Despite a lack of evidence of genetic differentiation from nuclear SNP loci, patterns of relatedness and genetic differentiation from mtDNA suggest natal philopatry at multiple geographic scales, with limited gene flow among sites possibly mediated by male dispersal. A priori clustering of sampled areas at an intermediate scale (eastern and western Bering Sea, Gulf of Alaska and Southeast Alaska) best explained the genetic variance (12.37%) among regions. In addition, mtDNA differentiation between the Gulf of Alaska and eastern Bering Sea, and among regions within the Gulf of Alaska, indicated significant genetic structuring of harbour porpoise populations in Southeast Alaska. The targeted collection of eDNA samples from strata within Southeast Alaska was key for elevating the statistical power of our mtDNA dataset, and findings indicate limited dispersal between neighbouring strata within coastal and inland waters. These results provide evidence supporting a population boundary within the currently recognised Southeast Alaska Stock. Together, these findings will prove useful for ongoing management efforts to reduce fisheries conflict and conserve genetic diversity in this iconic coastal species.

Effective Field Sampling of Rectoanal Mucosa-Associated Lymphoid Tissue for Antemortem Chronic Wasting Disease Testing in White-tailed Deer (Odocoileus virginianus).

Chronic wasting disease (CWD) is a fatal prion disease of cervids that has spread across much of North America. Although gold standard CWD diagnostics involve postmortem testing of medial retropharyngeal lymph nodes or obex (brain stem), a key tissue sample for antemortem testing is rectoanal mucosa-associated lymphoid tissue (RAMALT). However, collection of an adequate sample (i.e., enough lymphoid follicles) may be affected by factors such as deer age, repeated sampling, skill of the sampler, and adverse conditions during collection. Here, we document the protocol used to train personnel for RAMALT collection in a large study of free-ranging white-tailed deer (Odocoileus virginianus) in Wisconsin, USA, and determine factors that contributed to the occurrence of inadequate RAMALT samples. Our training protocol included hands-on experience with postmortem tissues, as well as a mentored collection process in the field. Collection of RAMALT under field conditions was highly successful, with 763/806 (94.7%) samples deemed adequate for subsequent testing. Although inadequate samples were rare, they were more likely to occur with older deer and when samples were collected at dusk (i.e., limited ambient lighting). We conclude that RAMALT collection can be highly successful under adverse field conditions, including with technicians with limited prior veterinary experience, and we provide details of our training program to facilitate repeatability in other antemortem CWD testing efforts.

Changes of microbial active ingredients and antioxidant capacity during fermentation process of dark tea

Dark tea, a traditional fermented tea in China, is known for its unique flavor and enhanced health potential due to its fermentation process. However, previous studies on the evolution of its active ingredients and antioxidant properties have been limited by inadequate sample collection, single analytical methods, and insufficient data processing. To address these challenges, this study employed a comprehensive strategy to analyze the dynamic changes of active compounds and antioxidant efficacy during dark tea fermentation using refined sampling, diverse assay techniques, and advanced data analysis. A multi-point temporal sampling method was used to capture key stages of fermentation, ensuring comprehensive data. High-Performance Liquid Chromatography (HPLC) and various antioxidant assays (1,1-diphenyl-2-picryl-hydrazyl (DPPH), 2, 2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS), Ferric ion reducing antioxidant power (FRAP)) enabled precise quantification of tea polyphenols, catechins, theaflavins, and thearubigins. Multivariate statistical analysis revealed that tea polyphenols and catechins decreased, theaflavins increased then slightly declined, and thearubigins steadily rose as fermentation progressed. These changes were linked to fluctuations in antioxidant capacity, peaking at around 30 mg/g of phenolic compounds. The study also explored optimizing fermentation to enhance the retention of beneficial components, maximizing antioxidant properties and improving product quality. This research advances the understanding of dark tea fermentation and supports the sustainable development of the dark tea industry.

Investigation of Shiga toxin-producing Escherichia coli and evaluation of the microbiological quality of raw vegetable sal-ads

Foodborne diseases (FBD) are a significant public health concern worldwide, affecting millions of people annually. Symptoms of FBD range from mild gastrointestinal discomfort to more severe conditions, which in some cases can lead to death. Raw vegetables, especially those consumed in ready-to-eat (RTE) salads, are particularly susceptible to microbial contamination. This study aimed to investigate the presence of Shiga toxin-producing Escherichia coli (STEC) and to evaluate the microbiological quality of 77 RTE raw vegetable salads from 20 restaurants in Niterói, RJ, Brazil. None samples presented STEC, nor the safety indicators (SI) Salmonella spp. and Listeria monocytogenes. However, 89.6% of the samples were considered unfit for human consumption, since they presented at least one hygiene indicator (HI) outside the established standards. The majority of samples (95.5%) were unsatisfactory for Enterobacteriaceae (EB), followed by total aerobic bacteria (TAB) (76.6%), thermotolerant coliforms (C45) (32.5%) and Escherichia coli (EC) (1.3%). The difference between the occurrences of hygiene indicators was not significant. Given the high percentage of inadequate samples found in the study, it is clear that there is a need for stricter surveillance and adequate hygiene practices in restaurants. To reduce the risks of microbial contamination in RTE raw vegetable salads, several approaches can be implemented. These include continuous training of food handlers, implementation of food safety management systems such as Hazard Analysis and Critical Control Points (HACCP), and regular inspections. In addition, consumers also play an important role by demanding safe food and following safe food handling and consumption practices at home.

Population isolation in the Plains spadefoot toad: causes and conservation implications.

Range disjunctions appear to be common in nature, although they may be caused by various factors. They may simply be an artefact of inadequate sampling. If real, they may be the result of colonization events or habitat change. With natural habitats showing increasing fragmentation because of human activity, understanding the cause of a disjunction can have important conservation implications. We investigate the geographical range of the Plains spadefoot toad, Spea bombifrons, a widely distributed species in the midwestern and southwestern United States, with a putative disjunct population in southern Texas. We combine GIS mapping, species distribution modeling, and population genetic analysis to investigate this putative disjunction. We establish that this southern Texas population is truly geographically disjunct and genetically distinct. Further, using climate projections we show that this unique population is at high risk of local extinction.

Pulmonary Hyalinizing Granuloma: Case Report and Discussion of Diagnostic Challenges and Terminology.

Pulmonary hyalinizing granuloma (PHG) is a rare, benign condition characterized by slow-growing pulmonary nodules, often mimicking malignant lesions radiologically. Its pathogenesis is unclear but is thought to result from an exaggerated immune response to persistent antigenic stimuli. This report presents a case of a 71-year-old male with PHG, incidentally detected during imaging for acute appendicitis. Diagnostic challenges arose due to the radiological resemblance to metastatic disease, and inadequate biopsy samples. Surgical resection revealed fibrocollagenous nodules with perivascular inflammatory infiltrates. Immunohistochemistry and special stains excluded malignancy and infection. The clinical course of PHG is typically benign, with surgery being the treatment of choice for solitary lesions. However, the current terminology may be misleading, as the lesions are not true granulomas but rather fibrosing lesions. Further research is needed to clarify the underlying pathophysiology and improve diagnostic accuracy.

Entropy Stacked Autoencoder based Diffusion Model (ESADM) and Fuzzy Clustering with Semi Supervised Fuzzy Graph Convolutional Network (FC-SSFGCN) for Rail Surface Defect Detection

Rails, fasteners, and other parts of railway track lines eventually develop flaws due to continuous strain from train operations and direct exposure to the environment; these faults directly affect the safety of train operations. Detecting defects on rail surfaces presents a formidable challenge due to the wide array of possible flaws and their unpredictable nature. However, Defect identification errors, massive variances, inadequate training sample availability, and weak contrast between faults and the surrounding background all contribute to the complexity of this procedure. In this work, rail surface and fastener flaws may be detected non-destructively using a multi-crack detection approach based on the Entropy Stacked Autoencoder Diffusion Model (ESADM). A novel approach, ESAFM, has been developed, combining a rail surface image encoder with a multi-layer, Stacked Autoencoder to extract latent materials from images showcasing different types of cracks. This integration reduces the need for significant processing resources by integrating easily into the conventional physically-based image workflow. Additionally, the Zero Shot-Semi Supervised Fuzzy Class Knowledge Graph (ZS-SSFCKG) method proposes Class Knowledge Graph Construction (CKGC), which constructs a CKG to elucidate the connection between defects and non-defects. Class features are learned by using a Fuzzy Clustering with Semi Supervised Fuzzy Graph Convolutional Network (FC-SSFGCN). The method employs a transformer encoder to capture distant relationships, allowing for the extraction of features from defect samples. This facilitates the acquisition of distinct defect image characteristics, as industrial defects vary in shape and size. The experimental results on the public Railway Track Fault Detection (RTFD)and Rail Surface Defect Datasets (RSDDs) with rail surface defects are collected from rail tracks surface defect detection.

Clinical Utility of Circulating Tumor DNA for Detecting Lung Cancer Mutations by Targeted Next-Generation Sequencing With Insufficient Tumor Samples.

Circulating tumor deoxyribonucleic acid (ctDNA) is increasingly applied in clinical practice. This study aimed to explore clinical utility of a minimal invasive and sensitive way of ctDNA for next-generation sequencing in non-small cell lung cancer (NSCLC) with inadequate tumor samples. Targeted DNA sequencing was performed on tissue biopsies and matched plasma samples from 60 patients with NSCLC. A total of 13 driving genes were detected in 60 matched tissue DNA (tDNA) and ctDNA samples. Overall concordance rate was 75.47%, with 77.55% sensitivity and 50% specificity. Epidermal growth factor receptor (EGFR) mutations were the most common in both tDNA and ctDNA samples. Among other mutated genes were tumor protein p53 (TP53), erb-b2 receptor tyrosine kinase 2 (ERBB2), anaplastic lymphoma kinase (ALK), cyclin-dependent kinase inhibitor 2A (CDKN2A), ros proto-oncogene 1, and receptor tyrosine kinase (ROS1). Mutations in b-raf proto-oncogene, serine/threonine kinase (BRAF), cluster of differentiation 274 (CD274), neurotrophin receptor tyrosine kinase 1 (NTRK1), and rearranged during transfection (RET) occurred only in plasma. The majority of mutations in both samples were single-nucleotide variants. Deletions were found in EGFR, BRAF, and TP53 in ctDNA, whereas in tDNA, deletions were only found in EGFR. In ALK, single nucleic acid-site amplification occurred simultaneously in tissue and plasma, but insertions and copy number variations were detected only in plasma. Identifying ctDNA mutations by targeted sequencing in plasma is feasible, showing the clinical value of ctDNA-targeted sequencing in NSCLC patients when tumor tissue sampling is insufficient or even impossible.

Preanalytical Errors in Hematology: Insights From a Tertiary Care Hospital.

Introduction Errors occur in the laboratory at any level of the testing process. Recognizing these errors may cause patient distress by delaying diagnosis and management until results are released. This study aims to assess preanalytical errors in the laboratory and suggests methods to prevent them to improve accuracy and efficiency in the hematology department of a tertiary care hospital. The background emphasizes the critical role of preanalytical procedures in ensuring accurate hematological diagnoses and highlights the frequent mistakes that occur during specimen collection, handling, and transportation. Staff training, process standardization, using suitable collecting and transport equipment, putting quality control measures in place, and using automation technologies are some strategies for reducing errors and speeding up turnaround times. To increase diagnostic accuracy, patient care outcomes, and laboratory efficiency, hematology laboratories should address preanalytical mistakes and employ fostering methods. Aims and objectives The objective of this research is to evaluate the frequency and characteristics of preanalytical errors within the hematology laboratory of a tertiary care hospital. The study seeks to gauge the scope of the problem, identify key factors contributing to these errors, such as issues in specimen collection, handling, and transportation, and highlight areas where improvements can be made. Also, it intends to assess how preanalytical errors affect hematological accuracy and turnaround times, with a focus on patient care outcomes, and recommend techniques to reduce preanalytical errors and improve the accuracy of hematological results. Materials and methods This study was conducted at the hematology laboratory of our hospital from January 2023 to June 2024 after getting proper approval from the Institutional Review Board (IRB approval number 294/08/2024/PG/SRB/SMCH). It is a retrospective analytical study, and the study population comprised samples of patients from the emergency, inpatient, and outpatient departments, which included 51,155 complete blood count (CBC) and 5,449 peripheral smear(PS) samples. The study included only test samples sent specifically for hematological analysis, while those sent for cytological, biochemical, or microbiological testing were excluded. The distribution frequency of the samples and the number of rejected samples were analyzed, and the results were then compared and correlated. Results During the study period, a total of 56,604 samples were processed in the hematology laboratory. Of these, 886 samples (1.3%) were rejected due to preanalytical errors. The most frequent error was submitting an insufficient sample (54.17%), while the least frequent was the use of an empty or defective tube (0.4%). In the emergency department, the primary issues were insufficient and clotted samples, while in pediatric cases, errors were mainly due to inadequate or diluted samples. Conclusion Preanalytical errors in hematology laboratories, though often overlooked, can significantly impact diagnostic accuracy and patient care. Our study highlights that a substantial portion of errors arise from inadequate sample collection and handling, particularly in emergency and pediatric cases. Adherence to standard laboratory techniques can dramatically reduce preanalytical errors.

Biopsy: The benchmark for diagnostic excellence amidst advanced technological advancements – A review

Biopsy remains a critical diagnostic tool for identifying oral lesions, vital for establishing a definitive diagnosis through the examination of both physical and microscopic tissue abnormalities. Despite technological advancements, biopsy is still the most trusted method among oral healthcare professionals, particularly when clinical, radiographic, and histopathological findings do not align. However, challenges can arise, such as inadequate tissue sampling or the need for deeper analysis. This article explores the skills and potential pitfalls in biopsy procedures, emphasizing the importance of integrating clinical and radiological information to uphold biopsy as the gold standard in diagnosis, even in today's advanced technological landscape.

WP2.5 - Impact of repeated phlebotomy in long-stay patients and patients requiring total parenteral nutrition

Abstract Introduction Blood tests are an essential for patient management. Repeated tests can be associated with harm. The study aimed to assess the consequences of repeated phlebotomy in patients with a long hospital stay or requiring total parenteral nutrition (TPN). Methods Retrospective data was collected from general surgical patients with a length of stay (LOS) of at least 14 days, over a period of 6 months. Biochemical parameters including haemoglobin were recorded on day of admission, day 14 and day 21. Complications following phlebotomy were also noted. Results 133 patients were identified. 84 patients had a LOS >21 days. The longest inpatient stay was 92 days. The most common pathologies were related to lower gastrointestinal disease at 45 cases. TPN was required in 35 cases. Average blood loss as a result of blood sampling was 325 ml/admission (105ml-850 ml), with associated average drop in haemoglobin of 20%. In 6 cases, haemoglobin dropped >40%. Rate of testing per admission length was 1every two days. (45 times as a peak) The most common complications noted were technical ( lab errors/ inadequate sampling). Other physical and psychological factors. A Full set of blood tests costs 150£. In our intervention, 4ml paediatric blood vacutainers (to 13 ml adult’s) were trialled in 10 cases. The results were very comparable. Potential 60% reduction in blood loss was noted. Conclusion careful clinical judgment and controlled approach with restricted practice towards phlebotomy is mandatory .It can be harmful, if not clinically required. Plus it’s expensive costs. Paediatric blood vacutainers can be a beneficial alternative in those requiring regular blood sampling.

Role of mTOR Inhibitors in Pediatric Liver Transplant Recipients: A Systematic Review.

Immunosuppressive medications play a crucial role in determining both organ and patient survival following liver transplantation (LT). Typically, immunosuppressive protocols for pediatric LT patients rely on calcineurin inhibitors (CNIs). While inhibitors of mammalian target of rapamycin (mTOR) have demonstrated beneficial outcomes in adult recipients of liver allografts, such as improved renal function post-LT, their application in pediatric liver transplant recipients is a subject of debate due to uncertain efficacy and potential adverse effects. This review evaluates the potential roles of mTOR inhibitors in the context of pediatric LT patients. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol for conduct and reporting. Databases until 31 August 2023 were searched using specific terms and keywords. All clinical studies focusing on mTOR inhibitors in pediatric LT were included. Out of 888 identified articles, 30 studies, involving 386 children who had undergone liver transplantation and received mTOR-inhibitor-based immunosuppressive regimens, met the inclusion criteria. The beneficial impacts of switching from a CNI to an mTOR inhibitor or adding an mTOR inhibitor to CNI-reduced immunosuppression in LT pediatric patients with impaired kidney function are controversial, and high-powered clinical studies are need. It appears that enhancing immunosuppression by adding an mTOR inhibitor to CNI is helpful for pediatric LT recipients who are experiencing refractory acute rejection or chronic rejection. mTOR-inhibitor-containing regimens failed to reduce the occurrence of post-transplant lymphoproliferative disorders (PTLD) among children with LT that may be due to concomitant high CNI concentration among studied patients. The effectiveness of mTOR inhibitors in treating PTLD remains uncertain; however, in patients with PTLD who are at high risk of rejection, mTOR inhibitors may be administered. Conversion to or the addition of mTOR inhibitors to maintenance immunosuppression seems to be suitable for pediatric patients who received a transplant due to hepatic malignancies such as hepatoblastoma or hepatocellular carcinoma or for those with post-transplant primary or recurrent malignancies. Switching to an mTOR inhibitor may improve some CNI-related adverse effects such as gingival hyperplasia, neurotoxicity, nephropathy, hypertrophic cardiomyopathy, or thrombotic microangiopathy. Although the exact role of mTOR inhibitors among pediatric patients who have received a liver transplant needs further study, two algorithms are presented in this review to guide conversion from CNIs to mTOR inhibitors or the addition of mTOR inhibitor to a CNI-minimization immunosuppressive regimen for pediatric patients who may benefit from this class of drugs. This review mainly consisted of retrospective studies with inadequate sample sizes and lacked a control group, which represents the main limitation of this study.

Enhancing training performance of convolutional neural network algorithm through an autoencoder-based unsupervised labeling framework for mineral exploration targeting

Convolutional neural networks (CNNs), a prominent deep learning approach, have garnered significant interest in the field of mineral potential mapping (MPM) due to their capability to capture and learn spatial features that traditional algorithms tend to overlook. The effectiveness of CNNs is closely tied to the quantity of training data available, thereby impacting the outcomes of MPM. Moreover, uncertainties arising from delineation of negative samples can compromise the reliability of MPM assessments. To deal with these challenges, we propose the utilization of an autoencoder-based anomaly detection technique for the purpose of annotating locations in an unsupervised manner. Subsequently, a CNN is trained using the unsupervised annotated data to generate a Fe prospectivity model within a specific region in Iran. To validate the effectiveness of the proposed method, we first perform an MPM with insufficient positive training samples that extract from the location of known occurrences. We then execute another MPM on a set of samples labeled based on the reconstruction error of an autoencoder network. When comparing the two prospectivity models, namely using augmented data or inadequate samples, it is evident that modeling with augmented data outperforms the MPM model trained with insufficient samples. This confirms the effectiveness of the adopted approach and shows that the unsupervised labeling technique proposed in this work can significantly improve the performance of the CNN in MPM.

O30 AVAILABILITY OF PROPERLY VALIDATED AUTOMATED BLOOD PRESSURE MEASURING DEVICES FOR CHILDREN: STRIDE BP SYSTEMATIC REVIEW

Background and Objective: Properly validated automated upper-arm cuff blood pressure (BP) measuring devices are currently recommended for office, home, and ambulatory BP measurement. However, the validation of BP devices in children presents additional challenges, necessitating separate studies. This study assessed the evidence on accurate automated BP devices in children. Methods: STRIDE BP (www.stridebp.org) performs periodic systematic PubMed searches to identify validation studies of automated cuff BP monitors. Validation studies including children (3-12 years) conducted using an established protocol, including the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018), ANSI/AAMI/ISO 2013/2009, ESH-IP 2010/2002, AAMI 2002/1992/1987, and BHS 1993/1990, were identified from the STRIDE BP database. Results: Of 569 validation studies included in the STRIDE BP database, 47 (33 devices) were identified including children. Among them, STRIDE BP rejected 29 studies of which 18 were reported as “device pass” in the published paper. Among studies rejected by STRIDE BP but published as “pass”, main reasons for rejection were violations in the BP measurement procedure (sequence, number, repeats) (50%), inadequate reference device or cuffs for reference and test device (16.6%), inadequate sample size (22.2%), and single observer for reference BP (22.2%). Eventually 18 studies in children (38.3%) fulfilled all the validation protocol requirements, and 16 devices (10 available on the market) met the validation requirements and can be recommended for use in children. When additional ‘equivalent’ devices were considered (devices lacking validation studies but with differences from validated devices not affecting the measurement accuracy), 21 devices were found to be accurate, with 13 of them available on the market (Table). Conclusions: This analysis highlight a serious shortage of properly validated BP devices for children available in the market, with published validation studies often having major methodological issues. There is an urgent call to manufacturers and investigators to develop and properly validate more BP devices for children. TABLE. Validated devices for office, home, and ambulatory BP measurement in children.

Endometrial pathology in abnormal uterine bleeding (AUB) & role of different techniques of endometrial sampling in evaluation of AUB: A cross-sectional study

: Abnormal uterine bleeding (AUB), traditionally defined as uterine bleeding that is abnormal in volume, regularity, and/or timing. It affects 14–25% of women of reproductive age. AUB has a major impact on quality of life of women. Aetiology of AUB may be structural and functional and varies with the age group. Histology of endometrium remains the mainstay in diagnosis of pathology and management of AUB. Various techniques such as endometrial sampling by pipelle, dilatation and curettage (D & C) and hysteroscopy are used to obtain endometrium for histological diagnosis. A single center prospective cross-sectional study at teaching institute was carried out to include 150 females from 18-70 years presenting with abnormal uterine bleeding. Objective of study was to analyse prevalence of various endometrial pathologies in AUB, symptomatology as well as age wise distribution of various endometrial pathologies in AUB and compare feasibility of different techniques of collecting endometrial sample. Endometrial sample was obtained either by OPD Pipelle brush or Surgical Dilatation and Curettage method or hysteroscopy. Statistical Analysis was done by using Epi-Info-7 software.Commonest age group presenting with AUB was 41-50 (40%) years, 64% were para 3 or more, Proliferative and secretary changes, 53(35.3%) and 24(16%) cases while endometrial hyperplasia without atypia 18 (12%) cases and with atypia 7 cases (4.7%), endometrial carcinoma 5 cases (3.3%) while endometrial polyp was seen in 8 cases (5.3%). Heavy menstrual bleeding with normal duration was the commonest presentation in 64%. Endometrial sampling technical failure was seen in 2 cases with pipelle biopsy while in 7 cases inadequate sample was obtained with pipelle and dilatation and curettage. Uterine perforation was seen in one case which was managed conservatively.Technical failure and inadequate sample needs to be addressed considering background high risk factors, TVS imaging, repeat sample and use of hysteroscopy may be offered case to case basis.

Hyperalgesia in Patients With a History of Opioid Use Disorder

Short-term and long-term opioid treatment have been associated with increased pain sensitivity (ie, opioid-induced hyperalgesia). Treatment of opioid use disorder (OUD) mainly involves maintenance with methadone and buprenorphine, and observations of heightened cold pain sensitivity among patients are often considered evidence of opioid-induced hyperalgesia. To critically examine the evidence that hyperalgesia in patients with OUD is related to opioid use. Web of Science, PubMed, and Embase between March 1, 2023, and April 12, 2024, were searched. Studies assessing cold pressor test (CPT) pain responses during treatment seeking, pharmacological treatment, or abstinence in patients with OUD history were included. Multilevel random-effects models with robust variance estimation were used for all analyses. Study quality was rated with the JBI checklist. Funnel plots and Egger regression tests were used to assess reporting bias. Main outcomes were pain threshold, tolerance, and intensity in patients and healthy controls, and unstandardized, standardized (Hedges g), and percentage differences (%Δ) in these measures between patients and controls. The association between pain sensitivity and opioid tolerance, withdrawal, and abstinence indices was tested with meta-regression. Thirty-nine studies (1385 patients, 741 controls) met the inclusion criteria. Most studies reported CPT data on patients undergoing opioid agonist treatment. These patients had a mean 2- to 3-seconds lower pain threshold (95% CI, -4 to -1; t test P = .01; %Δ, -22%; g = -0.5) and 29-seconds lower pain tolerance (95% CI, -39 to -18; t test P < .001; %Δ, -52%; g = -0.9) than controls. Egger tests suggested that these differences may be overestimated. There were some concerns of bias due to inadequate sample matching and participant dropout. Meta-regressions yielded no clear support for hyperalgesia being opioid related. Patients receiving opioid agonist treatment for OUD are hypersensitive to cold pain. It remains unclear whether hyperalgesia develops prior to, independent of, or as a result of long-term opioid treatment. Regardless, future studies should investigate the impact of hyperalgesia on patients' well-being and treatment outcomes.

Impact of corner radius of the aperture on the accuracy of phase retrieval analysis in single-frame CDI for nanomaterials

Numerous efforts have been developed to advance the process of Ptychography, leading to the emergence of a phenomenon known as single-frame Coherent X-ray Diffraction Imaging (CDI). It represents an advanced form of Ptychography in which a well-defined coherent X-ray beam is directed onto the sample to generate a diffraction image that includes intensity information but lacks phase details. However, phase retrieval in single-frame CDI faces challenges like overlapping loss, inadequate samples, or phase ambiguity due to the characteristics of this method. The optimising effort has been conducted in the form of aperture implementation to address these problems, particularly in the iterative phase retrieval domain. This study explores non-point symmetrical apertures, specifically triangles, to enhance image reconstruction quality in iterative phase retrieval. We developed a simulation methodology to explore the impact of corner radius on the apertures in performing single-frame CDI. Our simulator generates diffraction images for each shape, which are processed through iterative algorithms and deep learning to reconstruct images. The effectiveness of each shape is assessed by visualising the loss function results, providing insights into optimal aperture designs for diffraction imaging, and contributing to the resolution of phase retrieval challenges in single-frame CDI.