Management Options Research Articles

Banked Primary Progenitor Cells for Allogeneic Intervertebral Disc (IVD) Therapy: Preclinical Qualification and Functional Optimization within a Cell Spheroid Formulation Process.

Background/Objectives: Biological products are emerging as therapeutic management options for intervertebral disc (IVD) degenerative affections and lower back pain. Autologous and allogeneic cell therapy protocols have been clinically implemented for IVD repair. Therein, several manufacturing process design considerations were shown to significantly influence clinical outcomes. The primary objective of this study was to preclinically qualify (chondrogenic potential, safety, resistance to hypoxic and inflammatory stimuli) cryopreserved primary progenitor cells (clinical grade FE002-Disc cells) as a potential cell source in IVD repair/regeneration. The secondary objective of this study was to assess the cell source's delivery potential as cell spheroids (optimization of culture conditions, potential storage solutions). Methods/Results: Safety (soft agar transformation, β-galactosidase, telomerase activity) and functionality-related assays (hypoxic and inflammatory challenge) confirmed that the investigated cellular active substance was highly sustainable in defined cell banking workflows, despite possessing a finite in vitro lifespan. Functionality-related assays confirmed that the retained manufacturing process yielded strong collagen II and glycosaminoglycan (GAG) synthesis in the spheroids in 3-week chondrogenic induction. Then, the impacts of various process parameters (induction medium composition, hypoxic incubation, terminal spheroid lyophilization) were studied to gain insights on their criticality. Finally, an optimal set of technical specifications (use of 10 nM dexamethasone for chondrogenic induction, 2% O2 incubation of spheroids) was set forth, based on specific fine tuning of finished product critical functional attributes. Conclusions: Generally, this study qualified the considered FE002-Disc progenitor cell source for further preclinical investigation based on safety, quality, and functionality datasets. The novelty and significance of this study resided in the establishment of defined processes for preparing fresh, off-the-freezer, or off-the-shelf IVD spheroids using a preclinically qualified allogeneic human cell source. Overall, this study underscored the importance of using robust product components and optimal manufacturing process variants for maximization of finished cell-based formulation quality attributes.

Advances in Adenomyosis Treatment: High-Intensity Focused Ultrasound, Percutaneous Microwave Therapy, and Radiofrequency Ablation.

Background/Objectives: Adenomyosis is a debilitating gynecologic condition that affects both multiparous older women and nulliparous younger women, inducing a variety of symptoms such as dysmenorrhea, menorrhagia, and infertility. Thermal ablation techniques are new procedures that have been proposed for the treatment of adenomyosis. They include high-intensity focused ultrasound (HIFU), percutaneous microwave ablation (PMWA), and radiofrequency ablation (RFA). Because thermal ablation techniques are minimally invasive or noninvasive, fertility is not impaired while symptoms improve. In addition, hospital stays and financial costs are generally reduced, increasing the interest in these alternative management options. Methods: In this narrative review, we conducted a thorough literature search of PubMed/Medline from the database inception to September 2022. In our search, we focused on noninvasive treatment methods such as HIFU ablation, RFA ablation, and PMWA as well as adenomyosis-specific terms and noninvasive techniques (ultrasonography, ultrasound, or magnetic resonance imaging). The queries were a combination of MeSH terms and keywords. The search was limited to the English language. Abstracts were screened according to their content, and relevant articles were selected. Results: Overall, the results showed that the above-mentioned ablation techniques are effective and safe in providing adenomyosis treatment. Lesion size and uterus volume are reduced, leading to considerable symptom alleviation with all three methods. Positive results concerning safety and fertility preservation have been described as well. Conclusions: Nonetheless, more research is required in this field to compare the efficacy and safety of different ablation techniques with traditional therapies. Such research will help improve these procedures and their associated decision-making processes.

Harnessing the Power of Fermented Tea to Improve Gut Microbiota and Combat Obesity Epidemic.

The global rise in obesity rates has prompted a thorough evaluation of dietary strategies that may alleviate this metabolic issue. Fermented tea, a beverage rich in polyphenols and catechins, has emerged as a viable therapeutic option for obesity management. This review discusses the role of fermented tea in modulating the gut microbiome, a critical factor in energy regulation and obesity. We explore how the bioactive components in fermented tea influence gut health and their implications for metabolic health. Fermented tea may inhibit weight gain and fat accumulation in obese animal models, likely by promoting beneficial bacteria and suppressing harmful species. Changes in the production of short-chain fatty acids and improvements in gut barrier integrity are linked to enhanced insulin sensitivity and reduced inflammatory markers, essential for effective obesity management. However, barriers remain in applying these findings in clinical settings, such as the need for standardized fermentation techniques and accurate dosage assessments. This review underscores the therapeutic potential of fermented tea in obesity treatment and advocates for further research to enhance its integration with public health initiatives.

Pilot Clinical Safety and Efficacy Evaluation of a Topical 3% Tranexamic Acid Cream and Serum Protocol for Managing Facial Hyperpigmentation in Caucasian Patients

Facial hyperpigmentation is a highly prevalent dermatological condition, characterized by dark spots on the skin resulting from excess melanin production. Hyperpigmentation significantly impacts patients’ quality of life and self-esteem. Current treatments often present disadvantages linked to poor product tolerability. A topical cosmetic approach combining three lightening active ingredients (tranexamic acid, niacinamide, vitamin C) offers a new option for treating dark spots on the skin. The present in-use test under dermatological control evaluated the clinical safety and efficacy of a cream and serum containing these three ingredients, formulated with hyaluronic acid for enhanced delivery, stability, and efficacy. A total of 22 Caucasian patients with facial hyperpigmentation, both male and female, aged between 45 and 67 years, applied the cream and serum for 8 weeks. Clinical assessments, colorimetric evaluations, standardized photography, and self-assessment questionnaires were used to measure outcomes. No serious adverse effects were recorded, and the incidence of local adverse effects was low, highlighting good tolerability of the investigated test items. In most participants, significant improvements in hyperpigmented areas were recorded. Clinical scoring by the dermatologist investigator indicated a statistically significant 13% reduction in color intensity and a 6% reduction in the size of dark spots after 8 weeks of treatment. Colorimetric evaluation showed a statistically significant 1% increase in luminosity (L* parameter) and an 8% improvement in the Individual Typological Angle (ITA°) in endpoint, indicating lighter skin spots. Subjective assessments reflected high user satisfaction, with 95% of participants noting improvements in skin hydration and luminosity, and 77% reporting a reduced appearance of dark spots. Overall, the present work supports the use of tranexamic acid, niacinamide, and vitamin C as an effective and well-tolerated combined topical management option for hyperpigmentation. This combination offers a viable alternative to classical whiteners for individuals seeking to reduce facial skin coloration imbalance and improve skin tone.

2023 guidelines on the management of psoriasis by the Dermatological Society of Singapore.

Psoriasis is a multisystem, chronic, inflammatory dermatological disease. In routine clinical practice, the management of psoriasis varies significantly. The current study aimed to develop a set of practice guidelines relevant to dermatology practice in Singapore. The Psoriasis Therapeutic Guidelines Workgroup, comprising members of the Dermato-logical Society of Singapore with a subspecialisation in psoriasis, was convened to develop the guidelines. Clinical questions on selected topics were generated and refined by the workgroup. A literature search using PubMed was performed on their assigned topics from June 2013 to December 2023. The articles were included and graded based on the level of evidence. The guidelines address topics ranging from clinical assessment to practical considerations in the management of mild, moderate and severe psoriasis, including delivery of care, referrals to specialists and adherence to treatment. The recommended therapies include phototherapy, methotrexate, acitretin, cyclosporine; apremilast; topical corticoste-roids, calcipotriol, topical calcineurin inhibitors; and biologics (i.e. adalimumab, infliximab, secukinumab, ixekizumab, ustekinumab, etanercept) either in combina-tion or as monotherapy. Common therapeutic concerns relating to biologic use were addressed. Recommendations on generalised pustular psoriasis, palmoplantar pustular psoriasis and psoriatic arthritis were also made. Patients on systemic therapy would receive appropriate vaccine counselling. Therapeutic implica-tions in special populations, such as pregnant/ lactating women, children, the elderly, those undergo-ing surgery and those suffering from specific infections and cancer were addressed. These guidelines were developed for dermatologists, family physicians, rheumatologists and other specialists to support their selection of appropriate management options.

Perinatal administration of Saccharomyces cerevisiae UFMG A-905 prevents asthma development in the offspring of mice.

Asthma prevalence has been increasing in communities that become more urbanised. Our previous results showed that Saccharomyces cerevisiae UFMG A-905 prevented the development of asthma symptoms and characteristics in a dose-dependent manner. Perinatal programming theory proposes that early exposure to some stimuli may have a protective effect in adult life. The aim of this study was to evaluate the effects of perinatal administration of S. cerevisiae UFMG A-905 in the prevention of asthma in the offspring of mice. S. cerevisiae UFMG A-905 was cultured in YPD broth medium and administered to three groups of mice: before conception, during gestation and lactation (CGL group); during gestation and lactation (GL group); and only during lactation (L group). The offspring of these animals were sensitised and challenged with ovalbumin. Two control groups received saline in the same periods. After, in vivo measurements of airway hyperresponsiveness (AHR) were performed. Total and differential cell count in bronchoalveolar lavage (BAL); ELISA for interleukin (IL)-4, IL-5, IL-10, IL-13, and IL-17A in the lung homogenate or BAL; and ELISA for ovalbumin (OVA)-specific immunoglobulin E (IgE) were performed. The animals of the CGL, GL, and L group, when compared to the OVA group, presented a significant reduction of AHR ( P < 0.01), levels of IL-5 ( P < 0.001) in BAL, and IL-4 ( P < 0.05) and IL-13 ( P < 0.01) in the lung homogenate. Serum IgE levels were significantly higher ( P < 0.05) in CGL and GL groups when compared to the OVA group, but not in the L group. Only in the group L, there was a significant decrease in the number of total cells ( P < 0.01) and eosinophils ( P < 0.05). Perinatal administration of S. cerevisiae UFMG A-905 prevented the development of asthma-like characteristics and may be an option for asthma management. The protective effects on the offspring were more prominent when the yeast was given during lactation.

How dominant height responds to mixing species: Effect of traits and height difference between species

Adapting forests to climate change is a major challenge for forest ecology and forestry. Among the management options available, encouraging the use of mixtures is a promising way forward. However, this practice requires a thorough understanding of how species respond to mixing. In this article, we analyzed species dominant height responds to mixing and how species ontogeny and traits drive this response. We compared species observed dominant height in mixed even-aged stands with the expected dominant height of the same species in a monospecific stand under the same environmental conditions. We then related this dominant height variation due to mixing to between-species dominant height difference and to species traits linked to competition (shade tolerance, wood density, specific leaf area).We focused our analyses on 76 pairs of forest tree species. We used data from the French National Forest Inventory to calculate species dominant height in 1368 mixed stands. We then used previously developed models to estimate the expected dominant height in virtual monospecific stands with the same environmental conditions.We found that mixture had a significant impact on species dominant height for 15 out of 50 species-combination considered. Dominant height of a given species was higher in mixture than in pure stands when this species had a lower dominant height in pure stands, a lower shade tolerance, a lower specific leaf area or a higher wood density than its companion species.Our results suggest that species dominant height response to mixing depends on how mixture influences the competition for light. Our results will help inform strategies aiming to diversify species in forests, and will be especially useful in anticipating a given species’ behavior in response to competition for light when it is mixed with other species.

Pseudoaneurysm in the Axillary Tail of the Breast After A Core Needle Biopsy.

We present the case of a forty-year-old asymptomatic female with no personal or family history of breast cancer, who underwent a core needle biopsy (CNB) following the identification of a focal asymmetry in the right breast on screening mammography. Eight months later, a prominent adjacent vascular structure with a round outpouching was detected on breast ultrasound, confirmed as a post-biopsy pseudoaneurysm. Breast pseudoaneurysms, although exceedingly rare, result from inadvertent vessel puncture during core needle biopsies, particularly when larger gauge needles are used. They present as palpable, throbbing lumps in the breast and are well-defined heterogeneous structures that exhibit turbulent flow with a feeding artery on color Doppler imaging. This swirling sign showing a to-and-fro waveform is also known as the "yin-yang" sign on Doppler ultrasound. Post-CNB pseudoaneurysms in the breast, while rare, should be considered as potential complications following core need biopsy. Understanding their characteristic imaging features, risk factors, and available management options is essential for early diagnosis and appropriate treatment. This case underscores the importance of vigilance in biopsy procedures and the need for prompt recognition and intervention in case of such complications.

Rare complications of acute pancreatitis: Clinical cases

Background. Acute pancreatitis is recognized as a common disease, occasionally accompanied by the development of local complications that require surgical debridement. Rare complications of pancreatitis may occur in clinical practice, which is one of the reasons for their untimely diagnosis and treatment. Pancreaticopleural fistula and high small bowel obstruction develop in less than 1% of acute pancreatitis cases. Therefore, possible options for management of these complications are considered valuable. Description of clinical cases. The clinical examples, provided in the present paper, describe pancreaticopleural fistula and high small bowel obstruction that develop against the peripancreatic mass in the abdominal cavity. Patient K., 44, was hospitalized to the Regional Clinical Hospital of Emergency Medical Care, Krasnodar Krai, and preliminary diagnosed with bilateral hydrothorax and type II respiratory failure; pleural puncture was performed. Following the extended examination, a clinical diagnosis was made as follows: “Acute necrotic pancreatitis spreading to a pancreatic tail cyst. Reactive double pleurisy”. The postoperative period was indicated with repeated recurrence of right hydrothorax, and pancreaticopleural fistula (diagnosed by measuring amylase activity in the brown fluid effused from the right pleural cavity, which appeared to be 41216 IU/l (not normally determined)). The right pleural cavity and pseudocyst of the pancreatic tail were drained, resulting in obliteration of the pancreatbcopleural fistula. Patient V., 50, was hospitalized and transferred to the surgical department of the Regional Clinical Hospital No. 2, Krasnodar Krai, and diagnosed with “pancreonecrosis, extensive purulent-necrotic peripancreatitis.” The patient underwent puncture-drainage treatment. The postoperative period was complicated by acute small bowel obstruction. Surgical treatment involved Braun enteroesterostomy. The patient recovered. Conclusion. Pancreaticopleural fistula refers to a rare complication of acute pancreatitis, manifested by hydrothorax. Its diagnosis is based on the determination of amylase activity in the effusion. Drainage of the pleural cavity and pancreatic pseudocyst contributes to obliteration of the fistula. The intestinal obstruction, another complication of pancreatitis, requires open surgical treatment when a conservative therapy appears ineffective.

HPMC Extended-Release Multi-Composite Matrix for Co-delivery of Oxcarbamazepine and Vitamin D.

Background: Carbamazepine (CBZ) is considered as first-line treatment for epilepsy. The literature has signified a history of non-uniform drug performance and clinical failures. However, many studies suggested that Oxcarbazepine (OXC), a structural analog of CBZ, may have an equivalent antiepileptic effect. OXC follows a different metabolic pathway other than CBZ. However, both share the same mechanism of action by blocking voltage-gated sodium channels. Objectives: This study aimed to form hydroxypropyl methylcellulose (HPMC) extended-release tablets containing OXC combined with vitamin D. Methods: These formulated tablets were tested for their dissolution rate, tablet hardness, friability, thickness and pharmacokinetic parameters (Cmax and Cmin). Blood sodium levels were additionally investigated to ensure the absence of hyponatremia; the main side effect of long-term use of CBZ and some of its derivatives. Results: The use of HPMC inhibited the formation of dihydrate OXC form thus offering a significant extended-release profile. OXC also showed a highlighted capability to attain high bioavailability. Microcrystalline cellulose (MCC) was also added to tablets formed to inhibit polymorphic transformation. Tablets containing OXC co-delivered with vitamin D ensured significantly decreased susceptibility to hyponatremia, and an extended-release profile was evident. Lower amounts of OXC were loaded in formed tablets containing vitamin D owing to the synergistic effect between vitamin D and antiepileptic drugs. Conclusion: Conclusively, employing these newly HPMC-constructed tablets of OXC co-delivered with vitamin D appeared to be a promising option for the effective management of epilepsy with least side effects.

Giant ovarian mucinous cystadenoma complicating term pregnancy: A rare case report

Introduction: Adnexal masses in pregnancy are identified at a rate of 2 to 20 in 1000, which mostly are benign simple cysts. Although the majority of adnexal masses will resolve spontaneously by the beginning of the second trimester, some cases are persistent forms which can result in complications for both mother and fetus. Presentation of case: A 31-year-old pregnant woman was diagnosed with a left ovarian mucinous cystadenoma. The ovarian cyst was first detected in the 8th week of pregnancy, measured 5×5 cm and reached 40×30 cm at 38 weeks of gestation. The patient underwent an elective cesarean delivery along with left salpingo-oophorectomy at term. An alive female baby of 3000 grams was delivered with good APGAR scores at the first and fifth minutes. Histologic examination confirmed the diagnosis of a benign mucinous cystadenoma. Dicussion: The option of surgical intervention versus conservative management should be tailored to the patient’s physical symptoms, characteristics of tumor, and gestational age. An elective cesarean section along with salpingo-oophorectomy can be adopted for a giant ovarian cyst complicating term pregnancy. There is a risk of recurrence after a removal of ovarian mucinous cystadenoma. Conclusion: Ovarian cysts coexisting with pregnancy should be followed up properly by routine ultrasound and regular antenatal care. The decision to postpone surgical management of a complex mass until the time of delivery must balance the risks and benefits for mother and fetus. After surgery, the patient needs to be provided an appropriate follow-up care to manage postoperative recurrence.

Giant adolescent tubular adenoma of the breast mimicking giant fibroadenoma: a case report

Tubular adenomas are a rare benign breast neoplasm, often clinically indistinguishable from fibroadenomas or phyllodes tumors. We present a case of the largest adolescent tubular adenoma reported in the literature, measuring 12.5 cm. Radiological evaluation and histopathological assessment of the core biopsy sample was consistent with a giant fibroadenoma. However, the final histopathological analysis of the excisional biopsy sample confirmed a tubular adenoma. This case highlights the clinical conundrum of reaching the definitive diagnosis in a patient with a tubular adenoma. A contemporary review of the clinical features, radiology, histopathology and management options for tubular adenoma of the breast was undertaken.

Sustainable Natural Resources for Aphid Management: β-Ionone and Its Derivatives as Promising Ecofriendly Botanical-Based Products.

β-Ionone, sustainably derived from Petunia hybrida as a natural bioresource, was identified as a lead compound for integrated aphid management. A series of β-ionone derivatives containing ester groups were designed and synthesized for the purpose of discovering renewable botanical-based products. The odorant-binding protein (OBP) binding test indicated that β-ionone and its derivatives displayed binding affinities with Acyrthosiphon pisum OBP9 (ApisOBP9) and Harmonia axyridis OBP15 (HaxyOBP15). Bioactivity assays revealed that most β-ionone derivatives exhibited a higher repellent activity than that of β-ionone. β-Ionone and derivatives 4g and 4l displayed attractiveness to H. axyridis. Specifically, 4g was a highly promising derivative, possessing good repellent activity against A. pisum and attractiveness to H. axyridis. Molecular dynamics simulations revealed that integrating the hydrophobic ester group into the β-ionone framework strengthened the van der Waals interactions of 4g with ApisOBP9/HaxyOBP15, improving the binding affinity with OBPs and producing higher push-pull activity than β-ionone; 4g also had low toxicity toward nontarget organisms. Thus, 4g is a potential ecofriendly, botanical-based option for aphid management.

Retrospective analysis of surgical management options of hepatolithiasis in a tertiary care centre in Bangladesh

Background: Hepatolithiasis (HL) is the presence of stones in the bile ducts proximal to the confluence of the hepatic ducts. It is endemic in the Asia-Pacific region. The etiology of hepatolithiasis is not fully understood but genetic, dietary and environmental factors are thought to be contributory. Malnutrition and low socioeconomic conditions are associated with a high incidence of intrahepatic stones. This study aimed to analyze the demographic and clinicopathological factors, appraise the role of surgical management and analyse the postoperative outcomes of HL in a tertiary care centre in Bangladesh. Methods: This study was conducted in the Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplant (HBPS &amp; LT), BIRDEM General Hospital, Dhaka, Bangladesh. Retrospective data of all patients operated for HL from January 2011 to December 2022 were analyzed with regard to clinical parameters, biochemical parameters and different types of surgical management. Results: A total of 52 patients underwent surgical treatment for HL. Of the patients, 65.4% were female and 34.6% were male. Of the patients, 94.2% had abdominal pain, 57.7% had fever and 28.8% presented with jaundice. A total of 30.8% of patients had a history of previous biliary surgery. Liver atrophy was present in 38.5% of cases. Hepaticojejunostomy (HJ) alone was done in 36 (69.2%) patients, hepatic resection with bilioenteric anastomosis was done in 10 (19.2%) patients and hepatic resection with T-tube placement in common bile duct (CBD) done in 6 (11.5%) patients. Endoluminal access loop was done in 2 (3.8%) patients. On followup visits, 60% of patients were asymptomatic. There was no postoperative mortality. Conclusion: Results from present study revealed encouraging results with minimal post operative complications and no mortality. BIRDEM Med J 2024; 14(3): 137-142

Adaptive microbiome responses to anthracnose in sorghum: Enhanced network complexity and disease resistance across plant niches

Anthracnose threatens sorghum productivity globally, with yield losses exceeding 50 % in some cases, making it crucial to understand plant-microbe-pathogen interactions to develop effective, sustainable control strategies. To probe deeper into the complexity of plant-microbe-pathogen relationships, this study used high-throughput sequencing to characterize microbial communities present in association with sorghum leaves and seeds harvested from both anthracnose infected and uninfected control plants. Our analysis shows that the variation in the diversity and composition of the microbiome due to anthracnose is indicative of an adaptive regulation by coexisting microbes with a plant for enhancing resistance against stresses. These changes were not only reflected by community composition, but also had remarkable effects on the topological properties of microbial ecological networks which further influence certain functions as well as key functional guilds related to plant growth. The presence of anthracnose significantly increased network complexity and resistance in the phyllosphere and leaf endosphere meta-microbiome, which may reflect an adaptive microbiome response to pathogen. The seed-associated microbiomes, however, had relatively no change in diversity and network properties indicating a stable background that may repel pathogen invasion. The study also suggests that anthracnose may facilitate its spread through the reorganization of microbial communities and the enrichment of specific beneficial microbes, aiding in plant defense against pathogens. This is achieved through an upregulation of siderophore production, antimicrobial compounds, phosphate solubilization and sulfur metabolism-specifically genes. Our work also uncovers the possibility for microbiome transfer through phyllosphere-and seed associated microbiomes, thereby indicating that pathogen spread between both above and below ground plant niches limit management options. To conclude, the present study reveals fresh insights into how plant-associated microbiomes respond to anthracnose stress and offers insight on their prospective in sustainable agriculture.

Homoeopathic Management of Menopause: A Comprehensive Review

Background: Menopause signifies a crucial physiological shift in a woman's journey, denoting the halt of menstrual cycles caused by the gradual decline in ovarian activity. Conventional management options, such as Hormone Replacement Therapy (HRT), are effective but not devoid of risks and limitations. In contrast, homeopathy offers a holistic approach to symptom management, aiming to address the underlying cause of menopausal disturbances. Aim and Objective: By critically analyzing clinical studies, randomized controlled trials, and observational research, this paper seeks to elucidate the role of homeopathy as an alternative and complementary therapy for menopause. The objective is to provide insights into the potential benefits of homeopathy and contribute to the growing body of evidence supporting its use in menopausal care. Methodology: A comprehensive search strategy was done to identify relevant literatures from databases such as PubMed, SCOPUS, and Google Scholar. The selection of eligible studies was conducted according to predefined criteria for inclusion and exclusion. Results: Our findings resulted into nine studies that fulfilled the inclusion criteria, including randomized controlled trials, observational studies, and clinical trials. These studies collectively provided evidence of the efficacy of homeopathic medicines in managing various menopausal symptoms, including hot flushes, mood swings, and sleep disturbances. Conclusion: The reviewed literature suggests that homeopathy offers a promising avenue for managing menopausal symptoms, providing an alternative or complimentary approach to conventional therapies. Individualized treatment strategies tailored to each woman's unique symptomatology appear particularly beneficial. However, further clinical trials are needed to fully elucidate the efficacy and mechanisms of action of homeopathic interventions in menopausal care.

Autism Spectrum Disorder: Latest Advances in Treatment

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition marked by deficits in social communication and the presence of restricted, repetitive behaviours. Despite the global prevalence of ASD, its diagnosis and treatment remain challenging due to the absence of specific biomarkers and the heterogeneity of symptoms. ASD is incurable and current management options aim to minimize the symptoms and maximize the patients’ ability to function. There is no one standardized treatment for ASD at present, recommended medical interventions involve various therapies which include cognitive behavioral therapy alongside additional personalized pharmacological symptomatic treatments. New approach for ASD management includes sensory integration therapy (SIT) as well as dietary interventions, like gluten-free, casein-free and ketogenic diets. Other innovative treatment strategies are targeted at gut microbiome and include probiotic treatment and fecal microbiota transplant. In this review possible genetic variants associated with ASD are discussed as well as their influence on the manifestation and management of clinical symptoms. For a better understanding on how genetic variables impact drug effectiveness in individuals and the importance of pharmacogenetics in ASD. This paper aims to explore the available and possible treatment options as well the genetic components associated with ASD. In summary, this paper reviews the current and emerging treatment options for ASD.

Assessment of the calcium-silicate Polonite as a sorbent for thin-layer capping of metal contaminated sediment

Sediments contaminated with hazardous metals pose risks to humans and wildlife, yet viable management options are scarce. In a series of laboratory experiments, we characterized Polonite® – an activated calcium-silicate – as a novel sorbent for thin-layer capping of metal-contaminated sediments. We tested a fine-grained by-product from the Polonite production as a cheap and sustainable sorbent. First, Polonite was reacted with solutions of Cu, Pb, and Zn, and the surface chemistry of the Polonite was examined using, e.g., scanning electron microscopy to investigate metal sorption mechanisms. Batch experiments were conducted by adding Polonite to industrially contaminated harbor sediment to determine sorption kinetics and isotherms. Importantly, we measured if the Polonite could reduce metal bioavailability to sediment fauna by performing digestive fluid extraction (DFE). Finally, a cap placement technique was studied by applying a Polonite slurry in sedimentation columns.The results showed rapid metal sorption to Polonite via several mechanisms, including hydroxide and carbonate precipitation, and complexation with metal oxides on the Polonite surface. Isotherm data revealed that the sediment uptake capacity (Kf) for Cu, Pb, and Zn increased by a factor of 25, 21, and 14, respectively, after addition of 5% Polonite. The bioavailability of Cu, Pb, and Zn was reduced by 70%, 65%, and 54%, respectively, after a 25% Polonite addition. In conclusion, we propose that sediment treatment with low doses of the Polonite by-product can be a cheap, sustainable, and effective remediation method compared to other more intrusive methods such as dredging or conventional isolation capping.

In vitro co-culture system for investigating Armillaria root rot in Prunus spp. using a fiber-supported liquid approach.

In vitro co-culture techniques that allow the growth of plants and pathogens under controlled environmental conditions are being used to re-create host plant infection. These approaches reduce infection times, promote reproducibility, and enable a rapid evaluation of plant-pathogen interactions. As a result, these systems have become essential in breeding programs aimed at developing plant resistance to diseases. In this study, we developed and validated an in vitro co-culture system to investigate the Armillaria root rot (ARR) affecting Prunus spp. This disease, caused by fungi Armillaria spp. and Desarmillaria caespitosa, poses a severe threat to the stone and nut fruit industry due to the susceptibility of most commercial rootstocks to infection and the lack of effective management options for its control. The system consists of a fiber-supported liquid approach in sterile plastic vessels that allows a fast and reproducible fungal infection under controlled environmental conditions. The floor of the vessels was covered with a polyester-fiber matte and a germination paper that served as an interface between the mycelia and the plant roots. The vessels were subjected to inoculation with Armillaria mellea and D. caespitosa, and three Prunus genotypes ('Guardian®', 'MP-29', and Prunus cerasifera '14-4') were co-cultured with both fungi. Disease progression and plant and fungal biomass were monitored during co-culture. The presented in vitro co-culture approach facilitates the concurrent growth of Armillaria/Desarmillaria spp. and Prunus spp., excluding most of the limitations associated with greenhouses and field experiments. This system provides consistent and reproducible conditions for investigating a prominent plant disease affecting Prunus spp.

Bilateral iliac embolization for delayed postoperative vaginal cuff bleeding complicated by non-target embolization of the labia

This case describes a 41 year-old female who underwent a robotic-assisted total laparoscopic hysterectomy in the setting of adenomyosis which was complicated by postoperative vaginal bleeding requiring additional surgical management. She continued to have vaginal bleeding following re-operation and the decision was made to proceed with iliac artery embolization with Interventional Radiology. Following the embolization, the patient’s bleeding was well controlled. While it is well known that uterine artery embolization is an option for management of bleeding for patients with fibroids, there are no current cases reported in the literature of embolization following hysterectomy. This is a unique case with potential clinical impact for future management of postoperative bleeding complications.