Intestinal Stomas in Abdominal Surgery: Etiological Circumstances, Indications, High Gravity Factors and Complications

This is a retrospective study of 264 intestinal stomas performed in the surgical unit of the Emergency Clinical Hospital "Bagdasar Arseni", Bucharest, within a 7-year period (2015-2021) aiming to evaluate their evolutive complications, risk factors, management and prevention strategies. Material and method. Colostomies: 218 (82.57%) cases, ileostomies 46 (17.43%) cases. Temporary stomas (103 cases or 39.02%) were isolated stomas of discharge in 45 cases and associated with other colorectal procedures in 58 cases. Postoperative complications included general systemic complications in 60 (22.72%) cases and local complications specific to stomas in 84 (31.81%) cases and common to abdominal surgery in 94 (35.60%) cases, which were solved by reoperation in 51 cases, with a reintervention rate of 19.31%. Stoma closures were performed in 34 (33.0%) of the 103 patients with temporary stomas. Of these, 26 (25.24%) patients died in the early postoperative period (< 30 days), the remaining 60 patients refused reintervention or were lost to follow-up. Conclusions. Faecal diversion still represents a therapeutic option for a wide range of benign or malignant digestive or extra-digestive abdominal diseases performed in emergency or scheduled surgeries, mostly for colorectal cancer and its complications.

Association between Maternal Neuraxial Analgesia and Neonatal Outcomes in Very Preterm Infants

Background  Although the use of neuraxial analgesia has been shown to improve uteroplacental blood flow and maternal and fetal hemodynamics related to labor pain, possibly improving immediate outcomes in term neonates, the association between neuraxial analgesia use and outcomes in preterm neonates remains unclear. Objective  The aim of this article was to evaluate the association between maternal use of neuraxial analgesia and neonatal outcomes in very preterm infants. Methods  This is a retrospective cohort study of women delivering singleton neonates between 23 and 32 weeks' gestation at a large academic center between 2012 and 2016. Outcomes of neonates born to women who used neuraxial analgesia for labor and/or delivery were compared to those whose mothers did not. Multivariable logistic regression was utilized to assess the independent associations of neuraxial analgesia use with neonatal outcomes after controlling for potential confounders, including gestational age, mode of delivery, and existing interventions to improve neonatal outcomes of prematurity. Results  Of 478 eligible women who delivered singleton very preterm neonates in this study period, 352 (73.6%) used neuraxial analgesia. Women who used neuraxial analgesia were more likely to have delivered at a later preterm gestational age, to have a higher birthweight, to have preeclampsia and/or hemolysis, elevated liver enzymes, low platelet count (HELLP), to have undergone labor induction, to have delivered by cesarean delivery, and to have received obstetric interventions such as magnesium prophylaxis for fetal neuroprotection, antenatal corticosteroids for fetal lung maturity, and antibiotics prior to delivery; they were less likely to have been diagnosed with a clinical abruption. Neuraxial analgesia was associated with decreased incidence of cord umbilical artery pH less than 7.0 (24.7 vs. 34.9%, p  = 0.03), as well as decreased incidence of neonatal intensive care unit length of stay over 60 days (35.5 vs. 48.4%, p  = 0.01), although these associations did not persist on multivariable analysis. On multivariable analyses, neuraxial analgesia remained independently associated with decreased odds of necrotizing enterocolitis (adjusted odds ratio [aOR]: 0.28, 95% confidence interval [CI]: 0.12-0.62) and grade III/IV intraventricular hemorrhage (aOR: 0.33, 95% CI: 0.13-0.87). These associations remained significant on sensitivity analyses, which were performed between 10 and 90% of the overall cohort in order to control for outliers, as well as between the subgroup of patients who received obstetric interventions. Conclusions  Maternal neuraxial analgesia use may be associated with lower odds of adverse outcomes in very preterm infants, even after controlling for existing interventions for prematurity. Prior work has suggested such effects may be due to improved neonatal acid-base status from changes in placental perfusion and maternal pain management, but further work is required to prospectively investigate such associations.

The Efficacy of Virtual-based Nutritional Interventions on Knowledge, Attitude, and Practices of Individuals with Hypertension: A Comparative Study Analysis

Introduction

Hypertension (HTN) is multifactorial, complex disorder predictable to affect all genders and foremost preventable risk factor for blood pressure and cardiovascular diseases.

Objectives

The present study was assessing the knowledge, attitude, and practices (KAPs) regarding HTN and creating the awareness of its better management among the hypertensive population through nutrition education intervention.

Methodology

A total of 82 participants were selected and questionnaire was used to elicit sociodemographic profile and KAP regarding HTN and its management. Nutrition education intervention was carried out through the online mode.

Results and Discussion

Results observed in preintervention between knowledge with attitude in experimental group and control group (r =+0.273 and r =+0.271), practice (r =+0.275 and r =+0.263), and attitude with practice (r =+0.521 and r =+0.186) were positive correlation similarly postintervention of both group obtained significant positive correlation. The statistical analysis of various sociodemographic factors of pre and postintervention in the experimental group and control group revealed a significant improvement in the mean posttest scores of KAP. Meanwhile, various sociodemographic factors obtained had nonsignificant (P > 0.005) in experimental group; a control group of pretest and posttest reported significant differences (P < 0.05). The posttest total mean score on nutritional knowledge and practice in the experimental group also showed a large significant (P < 0.05) increase when compared to the pretest mean score. There was no significant improvement in the total mean scores in any dimensions of the control group.

Conclusion

The study therefore helped the experimental group subjects in improving their overall knowledge about the importance of nutrition in HTN and also instilled positive attitude and practices toward the management of HTN through lifestyle modifications.

TransOrbital NeuroEndoscopic Surgery for Biopsy of the Left Cavernous Sinus: A Literature Review, Case Report, and Cadaveric Proof of Concept

The aim of this report is to describe TransOrbital NeuroEndoscopic Surgery (TONES) as a safe alternative for obtaining a cavernous sinus (CS) biopsy. We describe this technique in a patient with a diffuse large B cell lymphoma mimicking Tolosa-Hunt's syndrome. Articles were gathered querying PubMed, Embase, and Scopus databases with terms related to a "transorbital neuroendoscopic approach." The literature search was performed by two independent authors (N.L.F. and J.R.), with inconsistencies resolved by the senior author (M.M.D.V.). After screening abstracts for relevance, full-length articles were reviewed for pertinent variables. A comparison was conducted with the illustrative case of a 69-year-old woman who presented to the emergency department with vertigo, ophthalmoplegia, and diplopia for 2 months. A brain magnetic resonance imaging revealed an infiltrative lesion at the left CS. A presumptive diagnosis of Tolosa-Hunt syndrome was made, but a confirmatory biopsy was performed using TONES. Based on our cadaveric study, literature review, and case report, the TONES approach was safe, effective for tissue diagnosis, and associated with minor morbidity and reduced hospital stay. Additional prospective studies are required to study its viability and safety in a larger group of patients.

Morbillivirus: A highly adaptable viral genus

Over the course of human history, numerous diseases have been caused by the transmission of viruses from an animal reservoir into the human population. The viruses of the genus Morbillivirus are human and animal pathogens that emerged from a primordial ancestor a millennia ago and have been transmitting to new hosts, adapting, and evolving ever since. Through interaction with susceptible individuals, as yet undiscovered morbilliviruses or existing morbilliviruses in animal hosts could cause future zoonotic diseases in humans.

Pediatric human immunodeficiency virus infection presenting as symptomatic hypocalcemia

Mother to child transmission still accounts for thousands of children being affected with human immunodeficiency virus (HIV) yearly. These children are often detected late in their disease course, most commonly presenting as protein energy malnutrition. Here we present a unique pediatric case who presented with severe symptomatic hypocalcemia. The case highlights the importance of vitamin D and calcium screening in this subgroup of HIV patients.

Recent Dengue Infection in Bangladesh: A Seasonal Endemic Progressing to Year-long Serious Health Concern

Dengue represents one of the most dangerous mosquito-borne viral diseases. Although the disease has been prevalent around the globe over the centuries, recent outbreaks of dengue have devasted the healthcare delivery system of many countries. Being a global infection, dengue virus (DENV) is endemically present mainly in Latin America and Caribbean countries as well as countries in South Asia. The recent outbreak of DENV infection has indicated an exceptional outbreak of DENV in some countries in South Asia. There has been a serious endemic of DENV during 2019. After a heterogeneous pause, another severe outbreak of DENV was reported in some Asian countries in 2023. Among the Asian countries, Bangladesh has reported an acute upsurge of DENV infection in 2023 with record numbers of fatalities. However, this pattern of DENV has not been detected in neighbors of Bangladesh, such as India or other countries in Southeast Asia. This provides an emergent task of dissecting the present DENV infection in Bangladesh from different angles to get insights for future containment of the DENV infection, not only in Bangladesh but also in other DENV endemic areas or DENV-native areas.

How to cite this article

Akbar SMF, Khan S, Mahtab M, et al. Recent Dengue Infection in Bangladesh: A Seasonal Endemic Progressing to Year-long Serious Health Concern. Euroasian J Hepato-Gastroenterol 2023;13(2):145-151.

Case of Autoimmune Hepatitis

Autoimmune hepatitis (AIH) accounts for cases of chronic liver disease with greater incidence in females than males. It has a bimodal distribution in the age group peaking around pubertal periods and later in the fourth to sixth decade of life. It is characterized by continual hepatocellular inflammation and necrosis which bears the potential to progress to fibrosis and cirrhosis. Approximately a third of the patients manifest with features of acute hepatitis while some patients may progress to chronic liver disease with acute liver failure manifesting in the form of jaundice and coagulopathy. Management has long involved administration of corticosteroids alone or in association with other immunosuppressants like azathioprine to achieve long-term remission. Response to therapy is significantly variable as few patients achieve remission while some may relapse, thereby becoming candidates requiring lifelong therapy. It can either present as insidious onset or acute with manifestations ranging broadly from fatigue malaise, lethargy right upper quadrant pain weight loss anorexia, and jaundice, where up to one-third of patients may have progressed to frank cirrhosis at the time of diagnosis. A 62-year female presented with complaints of facial puffiness more around the eyes, associated with profoundly reduced appetite, yellowish discoloration of the skin, conjunctiva since 1 month, and sudden onset generalized itching not associated with fever, joint pains, weight loss, vomiting, loose stools, rash, or bleeding manifestations. She was admitted for further evaluation and workup. Liver function test revealed predominant unconjugated hyperbilirubinemia with direct bilirubin of 0.7 mg/dL and indirect bilirubin of 1.6 mg/day and transaminitis. Further investigations showed significantly elevated immunoglobulin G (IgG) and 1:80 titer of antinuclear antibodies (ANAs). In view of the high suspicion of autoimmune etiologies, the patient was subjected to a liver biopsy that confirmed cirrhosis with moderate interface hepatitis in the background of negative viral serologies and substance abuse history. She was started on a steroid course on a monthly follow-up basis to ensure biochemical remission.

How to cite this article

Fatima R, Mohammed V, Fatima A, et al. Case of Autoimmune Hepatitis. Euroasian J Hepatogastroenterol 2023;13(2):166-168.

Follmann balanitis - A very rare presentation of primary syphilis

Syphilis is a sexually transmitted infection caused by Treponema pallidum. The primary stage of the disease manifests as a chancre. Balanoposthitis as a presenting feature of primary syphilis is a very rare presentation. A 26-year-old male presented with asymptomatic erythematous plaques involving the glans and prepuce after unprotected intercourse with a known female. Routine investigations, serology, and dark field examination were normal. Fontana-Masson stain revealed spirochetes and a diagnosis of syphilitic balanitis of Follmann was entertained. This rare presentation accounts for only 0.3%-0.5% of cases of primary syphilis and hence is highlighted in this case report.

Hemolysis in reverse grouping: Evaluation and implication of high titer isoagglutinin of two blood donors

Hemolysis is a positive agglutination reaction and is primarily associated with high anti-A or anti-B antibody titers. This high titer may result in no agglutination due to the "prozone" phenomenon. Platelet concentrate of high titer has an adverse effect on the recipient of the non-identical ABO blood group. Similarly, the blood products with higher titers of isoagglutinin have recently increased the incidence of intravenous immunoglobulins-related hemolysis. In this Asian subcontinent, the impact of O blood donors with high antibody titers or ABO incompatible platelets is hardly addressed. Blood was collected from two healthy donors and subjected to blood grouping as done routinely. Hemolysis was observed in the reverse grouping with the "B-"cell. Blood grouping was repeated with the conventional tube technique (CTT) where there was no agglutination with the "B"-cell. Suspecting the "prozone" phenomenon, serial dilution of anti-B was done by CTT, and the titer was found to be 1:256 and 1:128 in both cases. Then, the reverse grouping was repeated with a diluted serum (1:8), and the blood group was confirmed to be A RhD-positive and O RhD-positive, respectively. The absence of agglutination in a reverse grouping is not only an indicator of weak antibody but also a presentation of the "prozone" phenomenon. This could be differentiated by doing the titer of isoagglutinin. Hemolysis due to high agglutinin levels should be documented and evaluated, and blood components should be properly labeled to ensure that the product is transfused to the same blood group patients.

Fiberglass cloth coated by coffee ground waste-derived carbon quantum dots/titanium dioxide composite for removal of caffeine and other pharmaceuticals from water

Coffee ground waste from the coffee beverage preparation is mainly discarded and consequently ends up in landfill, which cause the contamination of caffeine in various environmental compartments. This study focuses on the upcycling of coffee-ground waste to carbon quantum dots (CQDs) for use as a modifying material to improve the visible light activity of titanium dioxide (TiO₂). The CQD solution was synthesized by hydrothermal method, which has an average size of 2.80 ± 0.63 nm. The CQDs/TiO₂ photocatalysts were prepared by combining CQD solutions at various amounts with sol-gel TiO₂ and then coated on the fiberglass cloths (FGCs). The photocatalytic application mainly focuses on the removal of caffeine from the water. The photocatalytic experiment was preliminary run in a simple batch reactor under visible light. The 5CQDs/TiO₂ coated FGC (5 mL of CQD solution/g of Ti-based on sol-gel) showed the best performance, and it was selected for the removal of caffeine and other pharmaceuticals (i.e., carbamazepine and ibuprofen) in the recirculating reactor. The removals of caffeine, carbamazepine, and ibuprofen after irradiation for 9 h were 82%, 88%, and 84%, respectively. The residual concentrations were significantly lower than the reported toxicity levels based on specific species. The changes in total organic carbon were observed, indicating the mineralization of pharmaceuticals in water. The 5CQDs/TiO₂ coated FGC showed good flexible performance. No obvious loss of activity was observed for five runs. The actual wastewater from the coffee pot cleaning process was also tested. The removal was 80% for caffeine and 86% for color in the unit of the American Dye Manufacturers Institute (ADMI).

Effect of donor parameters and cell separators on yield of apheresis platelet and their impact on corrected count increment in aplastic anemia patients

BACKGROUND

The new cell separators make it simple to collect single donor platelets (SDP), although the platelet yield may vary depending on the cell separator used and donor-related clinical and laboratory variables.

AIMS

This study aims to study the factors affecting SDP yield and corrected count increment (CCI).

MATERIALS AND METHODS

This retrospective study was carried out at a tertiary care facility in northern India, over 4 years (May 2017-April 2020), data were retrieved and analyzed.

STATISTICAL ANALYSIS

Categorical variables were presented as proportions, while continuous variables were presented as mean with standard deviation, P < 0.05 was considered significant.

RESULTS

We found a positive correlation between predonation platelet count and yield (r = 0.243, P = 0.000). No such significant correlation was found with Hb concentration (r = 0.025, P = 0.720), age (r = 0.016, P = 0.820), sex (r = -0.038, P = 0.584), and weight (r = -0.025, P = 0.714). Maximum platelet yield and minimum time were seen with Trima. Only 39.3% (33/84) meet the 24 h CCI. The majority of patients did not meet the desired CCI could be due to the patients' clinical condition. On logistic regression, we found a significant association of 24 h CCI with product yield (odds ratio [OR] = 0.168, P = 0.015) and posttransfusion platelet count (OR = 0.454, P < 0.05).

CONCLUSION

The only donor-related factor that influences yield is predonation platelet count, whereas 24 h CCI may depend on the clinical status of the patient and yield.

Hemolytic disease of the fetus and newborn due to minor blood group alloimmunization in a mother of sickle cell disease with multiple alloantibodies

Hemolytic disease of the fetus and newborn is due to maternal IgG antibodies that transport through the placenta and destroy neonatal red cells. A mismatch of antigens between mother and fetus causes isoimmunization resulting in mild anemia, which may progress to fetal hydrops in the intrauterine period and severe hyperbilirubinemia to kernicterus in neonates. The isoimmunization is mainly caused by Rh-D and ABO antibodies. In this case report, we found neonatal hyperbilirubinemia due to the presence of anti-c alloantibody previously developed in a sickle cell disease (SCD) pregnant female. It is an unusual case of fetal hyperbilirubinemia due to minor blood group alloimmunization in a SCD needing exchange transfusion. Multi-transfused patients should be counseled regarding the need to perform antibody screening frequently before pregnancy for better treatment of both mother and child.

A case of hyperammonemia occurring during treatment of metastatic renal cell carcinoma with axitinib

Introduction

Although the incidence of hyperammonemia as an adverse event of tyrosine kinase inhibitors is quite low, several cases of tyrosine kinase inhibitor associated hyperammonemia have been reported. We report a case of hyperammonemia, that occurred during combined treatment with axitinib and pembrolizumab in a metastatic renal cell carcinoma patient without hepatic disorder or liver metastases.

Case presentation

A 77-year-old Japanese woman was diagnosed with metastatic renal cell carcinoma and was treated with pembrolizumab and axitinib. Both agents were subsequently discontinued due to hyperammonemia with hypothyroidism. After recovery, the patient resumed single-agent therapy with axitinib. However, hyperammonemia and hypothyroidism occurred again, suggesting axitinib-inducible adverse event. After nephrectomy, a lower dose of axitinib was restarted and continued safely for residual metastases under prophylactic treatment with aminoleban, lactulose, and levothyroxine.

Conclusion

The rare occurrence of hyperammonemia should be considered during treatment with VEGFR- targeted tyrosine kinase inhibitor including axitinib, and supportive prophylactic medication may be useful.

Long-term Safety and Tolerability of Omadacycline for the Treatment of Mycobacterium abscessus Infections

Background

Mycobacterium abscessus is a virulent human pathogen. Treatment is complex and often poorly tolerated with suboptimal rates of eradication, highlighting the need for improved therapeutics. This study reports clinical experience with omadacycline for treatment of M abscessus infections at five large nontuberculous mycobacterial (NTM) disease clinics across the United States to better understand long-term safety and tolerability.

Methods

We conducted a multicenter retrospective chart review of adults with M abscessus infections. All patients treated with omadacycline as part of a multidrug therapeutic regimen through December 2021 were included. Clinical data from time of omadacycline initiation and up to 12 months of follow-up were collected. Descriptive statistics were performed.

Results

Analysis included 117 patients. Among patients with M abscessus isolate subspeciation, 58 of 71 (81.7%) were M abscessus spp abscessus. In isolates with reported drug susceptibility testing, 15 of 70 (21.4%) had confirmed susceptibility to macrolides. The most common site of infection was lungs. Median duration omadacycline treatment was 8 months (range, 0.25-33 months; interquartile range, 4-15 months). Omadacycline was discontinued in 60 patients (51.3%); 20 completed planned treatment course, 23 experienced intolerance or adverse event leading to drug cessation, and 17 stopped due to cost, death (unrelated to NTM infection or therapy), or another reason. In those with pulmonary disease, 44 of 95 (46%) had 1 or more negative cultures at time of final microbiological assessment, with 17 of 95 (18%) achieving culture conversion.

Conclusions

This study reports data supporting long-term safety and tolerability of omadacycline along with signal of effectiveness in treatment of M abscessus infections.

Pericardial decompression syndrome with acute right ventricular failure: a case series

Background

Pericardial decompression syndrome (PDS) is an uncommon complication of pericardial drainage of large pericardial effusions and cardiac tamponade characterized by paradoxical haemodynamic instability following drainage. Pericardial decompression syndrome may occur immediately, or in the days following pericardial decompression, and presents with signs and symptoms suggestive of uni-/biventricular failure or acute pulmonary oedema.

Case summary

This series describes two cases of this syndrome which demonstrates acute right ventricular failure as a mechanism of PDS and provides insights into the echocardiographic findings and clinical course of this poorly understood syndrome. Case 1 describes a patient who underwent pericardiocentesis, whilst Case 2 describes a patient who underwent surgical pericardiostomy. In both patients, acute right ventricular failure was observed following the release of tamponade and is favoured to be the cause of haemodynamic instability.

Discussion

Pericardial decompression syndrome is a poorly understood, likely underreported complication of pericardial drainage for cardiac tamponade associated with high morbidity and mortality. Whilst a number of hypotheses exist as to the aetiology of PDS, this case series supports haemodynamic compromise being secondary to left ventricular compression following acute right ventricular dilatation.

Finding Strength in Times of Crisis? Post-Traumatic Growth During the Covid-19 Pandemic: A Saudi Arabian Perspective

This paper contributes to the Covid-19 literature by exploring the concept of post-traumatic growth (PTG) utilizing a mixed methods approach. The study examines to what extent the participants experienced positive growth and renewal arising from the prolonged period of lockdowns and emergency online learning. Exploring the experiences of 552 female undergraduate students in a private Saudi Arabian university, an online survey was utilized to gather the data. All the students had experienced online education as a result of the pandemic. The findings indicate the participants underwent a diversity of personal growth experiences. In addition, they also developed different coping mechanisms. The study provides insights into the responses of the students to the issues they were facing during the pandemic. It identifies ways in which participants experienced personal growth as well as a shift in perspective about their lives. There are implications for educators, counselors and policymakers emerging from this study.

Children's Experiences of Death Anxiety and Responses to the Covid-19 Pandemic

The aim of this study was to explore children's experience and responses to the Covid-19 pandemic through their illustrations and short narrations. During October 2020 and January 2021 data was collected from thirteen children aged 9-10 years old in a primary school in the North-West of England. Children were asked to draw their thoughts and feelings about the pandemic and to write a short narration to accompany the drawing. Thematic analysis of data revealed that during the pandemic children at this age have an understanding of death, experience death anxiety and are able to use creative expression to facilitate meaning of the impact of lockdown on their lives such as feeling isolated, lonely, sad and bored. Creative expression also facilitated adaptive coping mechanisms derived from being able to spend more time with family. The data on primary school children is part of a larger study which involved surveys and interviews with children aged 12-16 years in secondary schools.

'It was kinda like D.I.Y closure'. Using Photovoice to capture the experiences of final year social work students graduating amidst the pandemic

This article examines a recent research project that explored the lived experiences of 5 final year social work students in Scotland who graduated during the coronavirus pandemic. The project used Photovoice as the primary data collection method, followed by a 3 hour long online focus group where the participants and the researcher worked collaboratively to identify themes for further analysis. The findings demonstrated that while the data collected by participants through the photographs and captions were highly personal to each participant, there were recurring themes that connected all of them which were identified broadly as; (dis)connection, closure and identity - all of which were discussed in great detail in a virtual focus group after the data was collected. This article focusses predominantly on the Photovoice method adopted for the study and how this was an effective method for participatory research. This article also focusses on how the pandemic affected the transitionary period between the participants' identity shift from students to professionals. This study followed the principles of Participatory Action Research which meant that participants and the researcher worked together to cultivate and analyse the data collected and the findings that are discussed here reflect this collaborative process. As this report is being written, numerous new studies, reports and predictions as to the pandemics impact on our collective mental health emerge daily and so it is hoped that this project will serve as a small time stamp as to how the pandemic impacted this small group of students in Scotland and will honour their stories, creating a lasting space for them to be heard among the ever-increasing bombardment of news.

Assessment of the low-field magnetic resonance imaging for the brain scan imaging of the infant hydrocephalus

Objective

In today's global clinical settings, low-field magnetic resonance imaging (MRI) technology is becoming increasingly prevalent. Ensuring high-quality image acquisition is crucial for accurate disease diagnosis and treatment and for evaluating the impact of poor-quality images. In this study, we explored the potential of deep learning as a diagnostic tool for improving image quality in hydrocephalus analysis planning. This could include discussions on the diagnostic accuracy, cost-effectiveness, and practicality of using low-field MRI as an alternative.

Methods

There are many reasons which are going to affect infant computed tomography images. These are spatial resolution, noise, and contrast between the brain and cerebrospinal fluid (CSF). Now, we can enhance using the application of deep learning algorithms. Both improved and down quality were situated to the three qualified pediatric neurosurgeons comfortable with working in poor- to middle-level income countries for the analysis of clinical tools in the planning of the treatment of hydrocephalus.

Results

The results predict that a picture will be classified as beneficial for hydrocephalus treatment planning, according to image resolution and the contrast-to-noise ratio (CNR) between the brain and CSF. The CNR is significantly improved by deep learning enhancement, which also improves the apparent likelihood of the image.

Conclusion

However, poor-quality images might be desirable to image improved by deep learning, since those images will not offer the risk of confusing facts which could misguide the decision of the analysis of patients. Such findings support the newly introduced measurement standards in estimating the acceptable quality of images for clinical use.

Urodrill - a novel MRI-guided endoscopic biopsy technique to sample and molecularly classify muscle-invasive bladder cancer without fractionating the specimen during transurethral resection

The current diagnostic pathway for patients with muscle-invasive bladder cancer (MIBC), which involves with computed tomography urography, cystoscopy, and transurethral resection of the bladder (TURB) to histologically confirm MIBC, delays definitive treatment. The Vesical Imaging-Reporting and Data System (VI-RADS) has been suggested for MIBC identification using magnetic resonance imaging (MRI), but a recent randomized trial reported misclassification in one-third of patients. We investigated a new endoscopic biopsy device (Urodrill) for histological confirmation of MIBC and assessment of molecular subtype by gene expression in patients with VI-RADS 4 and 5 lesions on MRI. In ten patients, Urodrill biopsies were guided by MR images to the muscle-invasive portion of the tumor via a flexible cystoscope under general anesthesia. During the same session, conventional TURB was subsequently performed. A Urodrill sample was successfully obtained in nine of ten patients. MIBC was verified in six of nine patients, and seven of nine samples contained detrusor muscle. In seven of eight patients for whom a Urodrill biopsy sample was subjected to RNA sequencing, single-sample molecular classification according to the Lund taxonomy was feasible. No complications related to the biopsy device occurred. A randomized trial comparing this new diagnostic pathway for patients with VI-RADS 4 and 5 lesions and the current standard (TURB) is warranted.

Patient summary

We report on a novel biopsy device for patients with muscle-invasive bladder cancer that facilitates histology analysis and molecular characterization of tumor samples.

Research on the socioeconomic factors that influence the development of voluntary, non-remunerated blood donation in China-A correlation and regression analysis based on data from 2012 to 2018

Background and Aims

Previous research has shown that socioeconomic factors, such as income and education, are associated with blood donation behavior. This study aims to investigate the factors that influence blood donation behavior using a large database of blood donation records and to provide further empirical evidence and insights into the factors that influence blood donation behavior and to identify potential strategies to increase blood donation rates in China.

Methods

This study employed correlation analysis and regression analysis to investigate the impact of socioeconomic factors on blood donation rates in 36 major cities in China. The study also used the K-Means clustering algorithm to identify the socioeconomic factors that influence blood donation behavior at the per capita level. Additionally, the study conducted correlation analysis between the donor's age groups and the socioeconomic factors. The indices of economy and education were determined by correlation analysis.

Results

At the city level, overall economic output and university student populations were positively correlated with total blood donation times. However, at the per capita level, this linear relationship disappeared. By applying the K-Means clustering algorithm, the cities were divided into subgroups where the linear relationship reemerged. The study also found that the number of college students had a linear relationship with blood donors between the ages of 18-34.

Conclusion

City characteristics and demographics significantly impact blood donation rates in different ways. A universal policy may have limited effect given the heterogeneity across cities. Tailored interventions targeting specific city clusters and education levels are needed to promote blood donation behavior, especially among youth and students. Investment in education and targeted education on blood donation appear particularly impactful. A combined approach integrating social and economic policies will likely be most effective.