Initial Aspiration Research Articles

Acute myeloid leukemia with peripheral lymph node involvement in dogs: A retrospective study of 23 cases

Acute myeloid leukemia (AML) can infiltrate extramedullary tissues, such as the liver, spleen, and lymph nodes and can be difficult to differentiate from lymphoma in cytologic and histologic specimens. Our goal was to identify cytologic features that would support a diagnosis of AML in peripheral lymph node aspirates, for which we used the term extramedullary AML (eAML). Medical records of 23 dogs with a diagnosis of AML and archived lymph node aspirate smears from 2016 to 2024 were reviewed across 4 institutions. Inclusion criteria included ≥50% myeloid blasts plus differentiating myeloid cells in lymph node smears, confirmation of myeloid lineage by flow cytometric analysis, and complete medical records. Peripheral lymphadenopathy was the reason for presentation (9/23, 39%) or was found incidentally on physical examination (14/23, 61%). Most dogs were bi- or pancytopenic (18/23, 78%), with blasts identified in blood smears of 18 dogs (78%). Initial lymph node aspirate interpretations included hematopoietic neoplasia (8/21, 38%), AML (6/21, 29%), lymphoma (5/21, 24%), lymphoid hyperplasia (1/21, 5%), and granulocytic precursor infiltrates (1/21, 5%). On lymph node smear review, cytologic features supporting an eAML were differentiating granulocytes, blasts with myeloid features or promonocytes, dysplastic changes in myeloid cells, and retention of residual lymphocytes. The median survival was 22 days (range = 1-360 days), and 69% of 16 dogs given chemotherapy or glucocorticoids lived for 30 days or more. Our study highlights the importance of hemogram results and lymph node aspirate smear examination for morphologic features of myeloid differentiation to help diagnose eAML in lymph node smears.

Identify high-risk DOR women ≤ 35 years old following assisted reproduction technology through cutoffs of anti-mullerian hormone and antral follicle counts

BackgroundFemales with diminished ovarian reserve (DOR) have significantly lower cumulative live birth rates (CLBRs) than females with normal ovarian reserve. A subset of young infertile patients, whose ovarian reserve is declining but has not yet met the POSEIDON criteria for DOR, has not received the attention it merited. These individuals have not been identified in a timely manner prior to the initiation of assisted reproductive technology (ART), leading to suboptimal clinical pregnancy outcomes. We categorized this overlooked cohort as the “high-risk DOR” group.ObjectiveThe primary aim of this study was to identify high-risk DOR patients through anti-Mullerian hormone (AMH) and antral follicle counts (AFCs).MethodsA total of 10037 young women (≤ 35 years old) who underwent their first initial oocyte aspiration cycle at a single reproductive medicine center were included and further classified into three groups, based on the thresholds for AMH and AFC established through receiver operating characteristic (ROC) analysis and in alignment with the POSEIDON criteria. Two ROC analyses were performed to identify the cutoff values of AMH and AFC to obtain one viable embryo (one top-quality embryo or one viable blastocyst). The cutoffs of ROC were measured by sensitivity and specificity. The primary outcome was the cumulative live birth rate (CLBR) per oocyte aspiration cycle. The secondary outcomes included the number of oocytes retrieved and the number of viable embryos formed. Pearson’s chi-square tests were conducted to compare the clinical outcomes among the three groups. Furthermore, univariate logistic regression analyses were performed to investigate the associations between ovarian reserve and clinical outcomes. All of the above comparisons between the high-risk DOR and NOR were further confirmed by propensity score matching (PSM) (1:1 nearest-neighbor matching, with a caliper width of 0.02).ResultsAccording to the ROC analyses and POSEIDON criteria, the present study identified a population of high-risk DOR patients (1.20 ng/mL < AMH values < 2.50 ng/mL, with 6 ≤ AFC ≤ 10; n = 682), and their outcomes were further compared to those of DOR patients (positive control, AMH values ≤ 1.2 ng/mL, and/or AFC ≤ 5; n = 1153) and of NOR patients (negative control, 2.5 ng/mL ≤ AMH values ≤ 5.5 ng/mL, and 11 ≤ AFC ≤ 20; n = 2649). Patients in the high-risk DOR group had significantly lower CLBRs than those in the NOR group (p < 0.001) but higher CLBRs than those in the DOR group (p < 0.001). Logistic regression further demonstrated that high-risk DOR was associated with a lower likelihood of cumulative live birth chance (OR 0.401, 95% CI: 0.332–0.486, p < 0.001) than NOR was, with a greater likelihood of cumulative live birth chance (OR 1.911, 95% CI:1.558–2.344, p < 0.001) than DOR was. To investigate the effects of embryo development stage, the outcomes of D3 embryos and blastocysts were analyzed separately. Significant differences in pregnancy outcomes were detected only in D3 embryo ET cycles among the three groups (high-risk DOR vs. NOR, all p < 0.05; DOR vs. NOR, all p < 0.05). DOR/high-risk DOR did not influence the pregnancy loss rates or pregnancy outcomes (clinical pregnancy rates and ongoing pregnancy rates) per positive HCG cycle (all p > 0.05). After PSM, the differences in ovarian response and pregnancy outcomes between the high-risk DOR and NOR groups were consistent with the results before PSM.Conclusion(s)Our study revealed that the CLBR of the high-risk DOR patients was significantly lower than that of females with normal ovarian reserve and greater than that of females with DOR. The values of AMH ranging from 1.2 to 2.5 and AFC ranging from 6 to 10 appeared to constitute meaningful thresholds in females with mildly reduced ovarian reserve.

Reflecting on Two Decades of Community Informatics: Unfulfilled Promises and Unanticipated Challenges

This note critically examines the evolution of community informatics over the past two decades, evaluating its successes and shortcomings in creating a more just and equitable world. It reflects on the initial aspirations we held for community informatics, and contrasts them with the current landscape, dominated by challenges we did not foresee then, and by the transformative influence of artificial intelligence (AI). I also project potential future trends and issues in community informatics, emphasizing the need for proactive strategies to navigate a world increasingly shaped by corporate interests, AI-driven knowledge management, and the threat of misinformation to democratic processes.

Staged intervention to enable the resection of a large left temporoinsular cystic glioblastoma with language preservation: illustrative case.

Resection of glioblastoma (GBM) in eloquent regions depends on functional mapping to limit perioperative neurological morbidity. When neurological deficits preclude reliable mapping, neurosurgeons should explore potential mitigation strategies. The authors present the case of a patient with a large left cystic temporoinsular GBM and aphasia, for whom the authors used intraoperative language mapping and a staged approach to enable safe tumor resection. A 49-year-old female presented with progressive mixed aphasia for 1 month and new-onset right facial droop. Magnetic resonance imaging (MRI) revealed a large, heterogeneously enhancing, left temporoinsular tumor with a significant cystic component. Her aphasia was profound, and resection without reliable language mapping was deemed unsafe. An initial stereotactic tumoral cyst aspiration was performed, which reduced local mass effect and improved her language function. Cyst decompression thereby enabled both task-based functional MRI and intraoperative awake speech mapping, resulting in a safe resection of her GBM. Safe resection of eloquently localized GBM is compromised when neurological deficits prohibit intraoperative functional mapping. This case demonstrates a mitigation strategy specific to cystic lesions in which an initial-stage stereotactic cyst aspiration is aimed at generating sufficient interval neurological improvement, such that intraoperative functional mapping can be performed during a second-stage resection. https://thejns.org/doi/10.3171/CASE24362.

8062 Uncommon Presentation of Multiple Myeloma as a Rapidly Growing Thyroid Goiter Initially Thought to be Hashimoto's Thyroiditis

Abstract Disclosure: M.S. Shah: None. S. Humayon: None. K.P. Sanu: None. C. Peñaherrera: None. We present a unique case of an 85-year-old female with rapidly growing anterior neck swelling and subclinical hyperthyroidism, initially suggestive of Hashimoto's thyroiditis. The goiter initially responded well to steroids but rebounded back in size despite two courses of prednisone. This prompted further diagnostic workup which revealed unexpected findings, ultimately leading to the diagnosis of multiple myeloma involving the thyroid parenchyma and lymph nodes. The patient had no history of thyroid disorders or recent upper respiratory tract infections. She exhibited sudden neck swelling, mild subclinical hyperthyroidism, and positive TPO antibodies. Initial fine needle aspiration suggested lymphoid tissue with Hurthle cell differentiation, raising suspicion of Hashimoto's thyroiditis. Flow cytometry supported this diagnosis, but the potential for a Hurthle cell neoplasm persisted. Prednisone temporarily reduced thyroid size, but disease recurrence necessitated surgical excisional and incisional biopsies. Subsequent biopsies revealed plasma cell neoplasms consistent with multiple myeloma. The pathologic report confirmed MYC rearrangement, indicative of multiple myeloma involvement in lymph nodes and thyroid tissue. Protein electrophoresis revealed two restricted bands migrating in the gamma globin region. The patient experienced subclinical hyperthyroidism that evolved into euthyroidism over a month. Incidental findings included non-invasive, low grade papillary urothelial carcinoma. Disease progression was evident in a follow-up PET/CT, prompting oncology consultation. The patient initiated Revlimid with chemotherapy. Levothyroxine was prescribed for postoperative hypothyroidism, with adjustments based on thyroid panel results. This case report illustrates the intricate diagnostic challenges posed by multiple myeloma masquerading as a thyroid disorder. The unexpected evolution of the disease, marked by MYC rearrangement and metastatic spread, emphasizes the need for heightened vigilance in managing such cases. Clinicians should consider alternative diagnoses when treatment efforts fail to provide adequate response. This will ensure timely and appropriate management in clinical practice. This report contributes valuable insights into the diagnostic complexities and multidisciplinary considerations for addressing similar presentations in endocrine and oncology settings. Presentation: 6/1/2024

8062 Uncommon Presentation Of Multiple Myeloma As A Rapidly Growing Thyroid Goiter Initially Thought To Be Hashimoto's Thyroiditis

Abstract Disclosure: M.S. Shah: None. S. Humayon: None. K.P. Sanu: None. C. Peñaherrera: None. We present a unique case of an 85-year-old female with rapidly growing anterior neck swelling and subclinical hyperthyroidism, initially suggestive of Hashimoto's thyroiditis. The goiter initially responded well to steroids but rebounded back in size despite two courses of prednisone. This prompted further diagnostic workup which revealed unexpected findings, ultimately leading to the diagnosis of multiple myeloma involving the thyroid parenchyma and lymph nodes. The patient had no history of thyroid disorders or recent upper respiratory tract infections. She exhibited sudden neck swelling, mild subclinical hyperthyroidism, and positive TPO antibodies. Initial fine needle aspiration suggested lymphoid tissue with Hurthle cell differentiation, raising suspicion of Hashimoto's thyroiditis. Flow cytometry supported this diagnosis, but the potential for a Hurthle cell neoplasm persisted. Prednisone temporarily reduced thyroid size, but disease recurrence necessitated surgical excisional and incisional biopsies. Subsequent biopsies revealed plasma cell neoplasms consistent with multiple myeloma. The pathologic report confirmed MYC rearrangement, indicative of multiple myeloma involvement in lymph nodes and thyroid tissue. Protein electrophoresis revealed two restricted bands migrating in the gamma globin region. The patient experienced subclinical hyperthyroidism that evolved into euthyroidism over a month. Incidental findings included non-invasive, low grade papillary urothelial carcinoma. Disease progression was evident in a follow-up PET/CT, prompting oncology consultation. The patient initiated Revlimid with chemotherapy. Levothyroxine was prescribed for postoperative hypothyroidism, with adjustments based on thyroid panel results. This case report illustrates the intricate diagnostic challenges posed by multiple myeloma masquerading as a thyroid disorder. The unexpected evolution of the disease, marked by MYC rearrangement and metastatic spread, emphasizes the need for heightened vigilance in managing such cases. Clinicians should consider alternative diagnoses when treatment efforts fail to provide adequate response. This will ensure timely and appropriate management in clinical practice. This report contributes valuable insights into the diagnostic complexities and multidisciplinary considerations for addressing similar presentations in endocrine and oncology settings. Presentation: 6/1/2024

RNA Sequencing Analysis of Monocytes Exposed to Airway Fluid From Children With Pediatric Acute Respiratory Distress Syndrome.

Monocytes are plastic cells that assume different polarization states that can either promote inflammation or tissue repair and inflammation resolution. Polarized monocytes are partially defined by their transcriptional profiles that are influenced by environmental stimuli. The airway monocyte response in pediatric acute respiratory distress syndrome (PARDS) is undefined. To identify differentially expressed genes and networks using a novel transcriptomic reporter assay with donor monocytes exposed to the airway fluid of intubated children with and at-risk for PARDS. To determine differences in gene expression at two time points using the donor monocyte assay exposed to airway fluid from intubated children with PARDS obtained 48-96 hours following initial tracheal aspirate sampling. In vitro pilot study carried out using airway fluid supernatant. Academic 40-bed PICU. Fifty-seven children: 44 children with PARDS and 13 children at-risk for PARDS. None. We performed bulk RNA sequencing using a transcriptomic reporter assay of monocytes exposed to airway fluid from intubated children to discover gene networks differentiating PARDS from at-risk for PARDS and those differentiating mild/moderate from severe PARDS. We also report differences in gene expression in children with PARDS 48-96 hours following initial tracheal aspirate sampling. We found that interleukin (IL)-10, IL-4, and IL-13, cytokine/chemokine signaling, and the senescence-associated secretory phenotype are upregulated in monocytes exposed to airway fluid from intubated children with PARDS compared with those at-risk for PARDS. Signaling by NOTCH, histone deacetylation/acetylation, DNA methylation, chromatin modifications (B-WICH complex), and RNA polymerase I transcription and its associated regulatory apparatus were upregulated in children with PARDS 48-96 hours following initial tracheal aspirate sampling. We identified gene networks important to the PARDS airway immune response using bulk RNA sequencing from a monocyte reporter assay that exposed monocytes to airway fluid from intubated children with and at-risk for PARDS. Mechanistic investigations are needed to validate our findings.

Where does the future lie? Initial aspirations for return among newly arrived Ukrainian refugees in Norway

ABSTRACT The lives of millions of people, who fled from Ukraine after Russia's full-scale invasion in February 2022, were turned upside down from one day to the next. When faced with such an abrupt escape, what initial thoughts do refugees have about whether to remain in their new host country or to return when the war ends? In this study, we focus on refugees' initial return aspirations soon after their escape. We conduct an in-depth analysis of how individual background factors and circumstances affect refugees' aspirations to remain or return. Based on unique data collected during the months immediately following Russia's invasion of Ukraine, we use survey data on Ukrainian refugees in Norway to examine their return aspirations and what individual factors that affect these aspirations and qualitative interviews with Ukrainian refugees to explore the rationales for their initial aspirations. We find that only one-fourth plan to return to Ukraine as soon as the war ends. Our analysis of how individual factors affect initial return aspirations both support and contradict previous research. Thus, we discuss how our apparently contradictory findings provide theoretical nuances of how host country and refugee group characteristics interplay with individual predictors of initial return aspirations.

COVID-19, school closures and the retreat from educational aspirations.

As a shared external shock, the coronavirus pandemic (COVID-19) impacted health and well-being around the world. Mitigation strategies employed in many locations included school closures and travel restrictions. These strategies directly impacted educational access and opportunities and created economic stressors for families. This study examines how these direct impacts also altered educational aspirations for children and adolescents, an important predictor of educational attainment. We estimate multilevel regression models using two waves of data, collected in 2017-18 and 2020-21, from 1294 children and adolescents (Mean age = 13.1, SD = 2.8; 50.3% female) in Jalisco, Mexico, and 2201 children and adolescents (Mean age = 14.7, SD = 2.6; 49.1% female) in Chitwan Nepal. We examine changes in educational aspirations between the two waves (pre- and post-COVID-19 onset). Initial aspirations are positively associated with household wealth, caregiver education, and prior commitment to education. Multilevel regression models predicting changes in educational aspirations demonstrate these resources are important for maintaining high educational aspirations. But children and adolescents in households that experienced more economic loss following the external shock of the pandemic had lowered aspirations over time. Disruptions to schooling and economic shocks to households curtailed educational aspirations among children and adolescents in a similar way in two disparate settings. These results raise concerns about the educational attainment of children in the face of external shocks and the possibility that educational progress will stall in low resourced environments among the most vulnerable youth.

Orwell’s Animal Farm and Golding’s Lord of the Flies: A Comparative Study

The main aim of this article is to compare two emblematic works of 20th century British literature: George Orwell's Animal Farm and William Golding's Lord of the Flies. This comparative study adopts a New Critical analytical approach, focusing exclusively on the textual aspects of the novels independently of any external context or ideology. We examine in depth the plots, characters and settings of both works. The study is structured around three main themes. First, it examines the societies represented in the two novels. Secondly, it explores the power dynamics within these societies. Finally, it highlights the ultimate collapse of the societal ideals depicted in the two works. At the end of this analysis, several conclusions emerge: both works explore the creation of new societies emerging from those that have shown their limitations. The animals' ideal of society in Animal Farm and the children's societal project in Lord of the Flies fail because of similar power dynamics. Orwell's animals and Golding's children end up becoming the exact opposite of their initial aspirations. The animals in Animal Farm gradually adopt human behaviour, while the children in Lord of the Flies regress towards more animal behaviour. So, paradoxically and ironically, Animal Farm and Lord of the Flies share the same fundamental concern: the fragility of human society and the fine line between humanity and animality. By exploring in detail the themes and connections between the two novels, this analysis aims to provide an in-depth understanding of how literature reflects and critiques the complexities of human social dynamics and the fragility of the societal structures.

Feasibility, tolerability, and first experience of intracystic treatment with peginterferon alfa-2a in patients with cystic craniopharyngioma.

Children with craniopharyngiomas (CPs) typically suffer from a life-long chronic disease. The younger the child, the more vulnerable the maturing brain is to invasive therapies such as surgery or radiotherapy. Therefore, treatment modalities facilitating avoidance or delay of invasive therapies are beneficial for these patients. In the last decade, intracystic injection of interferon alfa-2a or alfa-2b evolved as a treatment of choice based on efficacy and minor toxicity. However, the drug is no longer available internationally. After an extensive pharmacological review, peginterferon alfa-2a was identified as the agent with closest similarity. A retrospective case series is described, including five patients treated with intracystic peginterferon alfa-2a for cystic CP according to an innovative care protocol. After initial CP cyst aspiration, peginterferon alfa-2a was injected once per week via an Ommaya reservoir for 6 weeks followed by response assessment with MRI. Patients' age ranged from 4 to 54 years (four patients <12 years, one adult patient). Intracystic therapy with peginterferon alfa-2a was tolerated well by all five individuals without any major toxicities and resulted in cyst shrinkage in all of the five patients. The importance of a permeability study prior to commencing intracystic therapy became apparent in one patient who suffered from cyst leakage. Intracystic treatment with peginterferon alfa-2a was found to be a tolerable and efficacious treatment modality in patients with cystic CP. This experience warrants further research with a larger number of patients with measurement of long-term efficacy and safety outcomes.

Venetoclax combined with hypomethylating agents for favorable risk acute myeloid leukemia: A single center experience.

e18514 Background: Favorable risk acute myeloid leukemia (FR-AML) is typically treated with intensive induction chemotherapy followed by high dose consolidative cytarabine. However, a subgroup of FR-AML are not candidates for high intensity induction because of advanced age, comorbidities, or poor performance status. For these patients, hypomethylating agents (HMA) combined with venetoclax (HMA-Ven) is inferred as the standard of care based upon results of the VIALE-A trial; however, that trial enrolled only intermediate or poor risk AML. The efficacy of HMA-Ven in FR-AML is unclear. Here we present a single center experience of this regimen in FR-AML. Methods: In this retrospective single center case series, we collected data from all patients &gt;18 years old with newly diagnosed FR-AML between January 2018 to December 2022 at AdventHealth Orlando who were treated with HMA-Ven. Patient with relapsed/refractory disease or a diagnosis of acute promyelocytic leukemia were excluded. FR-AML was defined using ELN 2022 guidelines based on the results of genomic testing of the initial bone marrow aspirate. The primary endpoints were the complete remission (CR) rate and 1-year overall survival (OS). Statistical analyses were performed using the R survminer package. Results: Newly diagnosed FR-AML who received HMA-Ven were identified (n=12). The median age was 67.5 years. 3 (25%) cases had inversion of chromosome 16 and 9 (75%) had NPM1 mutations without FLT3-ITD mutations. 11 (92%) patients received decitabine and venetoclax. Patients received a median of 2.5 cycles of HMA-Ven, and all 12 patients achieved CR after one cycle of treatment. 6 (50%) patients were consolidated with intermediate-dose cytarabine (IDAC), 3 (25%) continued HMA-Ven, 2 (17%) underwent allogeneic stem cell transplant, and 1 (8%) received enasidenib. The 1-year OS was 80% (CI 0.59-1), and the median OS was not reached. 1 patient died due to chemotherapy toxicity with IDAC, and 1 patient died due to heart complications. 2 patients relapsed, 1 after IDAC and 1 after intolerance to further treatment after 6 cycles of HMA-Ven. Conclusions: Our findings suggest that HMA-Ven is an effective treatment for newly diagnosed favorable risk AML. All patients achieved CR with one cycle of treatment with most surviving more than one year. Large multicenter studies are needed to further validate these promising results.

An audit of “Repeat” fine needle aspiration cytology procedures in a cytopathology laboratory—An important quality indicator

Abstract Background: The cytopathology department mainly conducts audits to evaluate the diagnostic efficiency of procedures across different organs. However, the common occurrence of repeat aspirations, typical in many cytology laboratories, has largely been overlooked. This study sought to examine the frequency of repeat Fine Needle Aspiration Cytology (FNAC) procedures within a cytopathology laboratory and to explore the root causes for such repetition. Materials and Methods: A retrospective descriptive analysis was conducted at the cytopathology laboratory affiliated with a tertiary care facility. This study included all FNAC cases reported over six months. Data were extracted from cytology records, and multiple factors leading to repeat aspirations were examined. The rate of repeat FNAC procedures was calculated by dividing the number of “repeat” FNAC procedures in a specific month by the total number of FNACs performed. A quality manager set a benchmark of 15% for the repeat FNAC rate. Results: About 39 out of 303 FNACs (12.8%) were repeated for 6 months. Soft tissue lesions, predominantly lipomas, accounted for most (35.9%) of these repeated aspirations. The principal reason for the need for repeat aspirations was insufficient material obtained during the initial aspiration. Conclusion: In many laboratories, the frequency of repeat FNAC procedures and their root causes often need to be checked. Evaluating the quantity of repeat aspirations in a laboratory indicates its performance and is a vital quality measure, especially when accreditation is required. This research proved beneficial by providing valuable insights into the prevalence of repeat aspirations within a cytology laboratory.

Design, Development and Commissioning of the Boldrewood Towing Tank – A Decade of Endeavour

The process of design, build and eventual commissioning of the towing tank on the Boldrewood Innovation Campus is described. The design brief required a facility that would have a capability to test models at a commercial scale but that would be effective as teaching environment for the next generation of Naval Architects as well as providing a flexible space for future fundamental research. Each of these provided their own challenges but the eventual solution of a 138 m long, 3.5 m deep, 6 m wide facility has more than met the initial aspirations. Equipped with 12 independent 0.5 m wavemaking flaps at the West end, a passive beach at the East end, a deployable side beach along the South wall for post run wave absorption and a monocoque Aluminium alloy carriage, the Boldrewood towing tank has now been successfully operating for more than a year. The carriage position and speed are controlled by a twin winch arrangement using a laser positioning system and low embodied energy composite cables. The carriage can reach a maximum speed of 10 m/s with controllable acceleration rates and can have up to four constant speed phases per run. Initial commissioning results and comparisons with benchmark data for the KCS hull confirm the accuracy and repeatability of the facility. In particular, the position and speed of the carriage are known to a high level of precision. To date research and consultancy work has spanned the performance of high speed vessels, uncrewed underwater and surface vessels, wave energy and tidal current systems, floating platforms for wind turbines, performance sport work for sailing, kayaking, rowing and swimming, open water propeller tests as well as conventional displacement vessel testing for self-propulsion and resistance. All ship science and maritime engineering students use the facility as part of their taught modules in every year of their programme as well as for individual, MSc and group projects as appropriate. It has also made a strong impact on the many thousands of visitors a year to the campus for science and engineering open days.

BMAC Injection Improves 65-Year Old’s Knee Osteoarthritis Pain

This case study presents the challenging scenario of a 65-year-old male who suffered from debilitating knee pain resulting from preexisting arthritis. Despite various attempts to alleviate the pain, including a corticosteroid injection and activity modification, the patient’s condition continued to deteriorate, leading to limited mobility and reliance on a cane to ambulate. With the failure of conservative measures, the patient’s orthopedic surgeon contemplated the possibility of a total knee replacement. However, the patient opted for an alternative treatment plan involving bone marrow aspirate concentrate (BMAC) injections. After an initial left knee aspiration, two injections of BMAC were administered. Remarkably, three weeks after the first injection, the patient’s condition improved by 90%, and the pain during physical activities reduced significantly. At the patient’s final appointment, he reported being able to walk up and down the stairs without pain. Four months after treatment, the patient embarked on a journey to the Swiss Alps where he spent upwards of four hours a day climbing in the mountainous terrain. He expressed a total absence of pain while navigating up and down the steep landscape. This case study highlights the potential efficacy of BMAC injections as a non-surgical treatment option for knee osteoarthritis pain management. Further research is necessary to evaluate long-term outcomes of this treatment approach.

Clinical characteristics and outcomes of children with non-sinogenic Brain infections

Background Central Nervous System (CNS) suppurative infections are serious but rare conditions in the paediatric population. Data on long-term neurocognitive and quality of life outcomes in children recovering from these infections are lacking. Methods A retrospective cohort review of children <16 years with non-sinogenic infections undergoing neurosurgery was conducted. Data for patients admitted to Children’s Health Ireland at Temple St between 2008–2021 were analysed for clinical and microbiological profiles. Follow-up reviews evaluating neurological and academic sequelae and quality of life were performed. Categorical variables were analysed for unfavourable outcome with a p < 0.05 significance value. Results Forty patients were included with a mean age of 4.5 years and equal gender distribution. Fever (68%) and vomiting (58%) were the most common presenting complaints. Only fourteen (35%) patients presented with the classic triad of fever, headache, and focal neurological deficit. Meningitis/Encephalitis was the most common cause of suppurative infection (40%). Predisposing factors included congenital heart disease (18%), prematurity (15%) and immunocompromised status (10%). More patients received an initial Burr hole aspiration (73%) than Craniotomy (27%). The re-operation rate was higher in the craniotomy group (45%) compared to the burr hole group (34%), but this was not statistically significant (p = 0.522). Four patients died (10%) including two intra-hospital deaths (5%). Male gender (p = 0.047) and multiple abscesses (p = 0.041) were associated with unfavourable outcome at discharge. Mobility impairment was the most affected determinant of quality of life. Conclusion CNS suppurative infections are associated with long-term neurocognitive sequelae in children. Multiple abscesses and male gender are associated with unfavourable GOS on discharge. Children are still left with mobility impairment (25%), personality changes (23%) and intellectual disability (18%) at an average of 5 years. Long-term follow up with multidisciplinary input is required. Further research should focus on evaluating long-term HRQoL in children.

Revisiting the Paradigm of Reaction Optimization in Flow with a Priori Computational Reaction Intelligence.

The use of micro/meso-fluidic reactors has resulted in both new scenarios for chemistry and new requirements for chemists. Through flow chemistry, large-scale reactions can be performed in drastically reduced reactor sizes and reaction times. This obvious advantage comes with the concomitant challenge of re-designing long-established batch processes to fit these new conditions. The reliance on experimental trial-and-error to perform this translation frequently makes flow chemistry unaffordable, thwarting initial aspirations to revolutionize chemistry. By combining computational chemistry and machine learning, we have developed a model that provides predictive power tailored specifically to flow reactions. We show its applications to translate batch to flow, to provide mechanistic insight, to contribute reagent descriptors, and to synthesize a library of novel compounds in excellent yields after executing a single set of conditions.

Revisiting the Paradigm of Reaction Optimization in Flow with a Priori Computational Reaction Intelligence

AbstractThe use of micro/meso‐fluidic reactors has resulted in both new scenarios for chemistry and new requirements for chemists. Through flow chemistry, large‐scale reactions can be performed in drastically reduced reactor sizes and reaction times. This obvious advantage comes with the concomitant challenge of re‐designing long‐established batch processes to fit these new conditions. The reliance on experimental trial‐and‐error to perform this translation frequently makes flow chemistry unaffordable, thwarting initial aspirations to revolutionize chemistry. By combining computational chemistry and machine learning, we have developed a model that provides predictive power tailored specifically to flow reactions. We show its applications to translate batch to flow, to provide mechanistic insight, to contribute reagent descriptors, and to synthesize a library of novel compounds in excellent yields after executing a single set of conditions.

Migration aspiration and desire of international students: Chinese international students under strain amid geopolitical tension and the COVID-19 pandemic

Confronted with restrictive visa policies, deteriorating US–China relations and the outbreak of the COVID-19 pandemic, Chinese international students in the United States face unprecedented uncertainty in their immigration prospects. Their unique intersectional identities as temporary immigrants, prospective permanent immigrants and emerging adults modulate their migration aspirations and desires within this exceptional social context. We interviewed and surveyed a group of Chinese international students in a major American university at various stages of their stay in the United States. Using the migration aspiration and desire framework, we explore how they cope with the challenges and plan for immigration upon graduation. Our findings suggest that under the unique temporal junction of the geopolitical tension and a global public health crisis unprecedented in their lifetime, the becoming process associated with their particular identity as in-between migrants and the assemblage of various actors throughout the process help recalibrate their initial aspirations at personal and collective levels and reshape their migration desires. Although it has frustrated their migration motivations and plans, it has also endowed them with perspectives and the capacity to develop effective coping mechanisms and remain resilient.

Diagnostic performance of molecular testing in indeterminate (Bethesda III and IV) thyroid nodules with Hürthle cell cytology

BackgroundIndeterminate thyroid nodules with Hürthle cell cytology remain a diagnostic challenge. The low benign call rate and positive predictive value of first-generation molecular tests precluded their use to rule out malignancy. We examined the diagnostic performance of current tests. MethodThis subset analysis of our prospective randomized trial compared the benign call rate and positive predictive value of Afirma Gene Sequencing Classifier and Thyroseq v3 in Bethesda III and IV nodules with Hürthle cell cytology. Molecular test samples were obtained at initial fine-needle aspiration (8/2017–7/2022) and reflexively sent for processing. ResultsMolecular testing was performed on 140 Hürthle cell nodules. Of 79 nodules tested with the Afirma Gene Sequencing Classifier, the benign call rate was 84% (66/79). Nine of 66 nodules with benign results were resected, with no malignancies. Twelve of 13 nodules with suspicious results were resected, revealing 3 malignancies—2 papillary thyroid carcinomas and one Hürthle cell carcinoma (positive predictive value 25%). Of 61 nodules tested with Thyroseq v3, the benign call rate was 56% (34/61; (P < .01 versus Afirma Gene Sequencing Classifier). Five of 34 nodules with negative results were resected, with no malignancies. Nineteen of 27 nodules with positive results were resected, revealing 3 malignancies—2 papillary thyroid carcinomas and 1 Hürthle cell carcinoma (positive predictive value 16%). ConclusionThe high benign call rate of current molecular tests in Hürthle cell nodules strengthens their value in enabling patients to avoid surgery.