Title :Leiomyoma beyond the uterus

In an increasingly digital world, access to information in various languages is vital. This paper introduces "ShabdSur," a groundbreaking application designed to transform text documents into multilingual audiobooks. ShabdSur leverages Flutter and Firebase technologies to offer a seamless user experience. Users can convert PDFs and images into audio files, making content accessible for people across language barriers. With support for over 10 Indian languages, it enables users to enjoy documents in their native tongue. Furthermore, ShabdSur features a translation option, allowing users to listen to content in their preferred language. The paper presents an overview of the app's functionality, its implementation, and user feedback, showcasing the potential impact of ShabdSur in bridging language gaps and expanding accessibility to diverse content.

Simultaneous occurrence of transient global amnesia and takotsubo syndrome triggered by caring for a terminally ill relative

Letter To the EditorWe read the article ”Retroperitoneal Schwannoma: Uncommon Location of a Benign Tumor” by Debaibi et al. 1 in the Journal of Clinical Case Reports in 2022 with great interest. While this research is undoubtedly valuable in contributing to our understanding of retroperitoneal schwannomas, it has come to our attention that certain aspects of the study merit further discussion and consideration.In the opening paragraph of the discussion section, the authors allude to the rarity of malignant transformation within schwannomas, except in cases of type 2 neurofibromatosis, citing Harhar et al. 20212. However, this statement is inaccurate, as Harhar et al. reported that up to 60% of individuals with Von Recklinghausen’s disease, specifically referring to neurofibromatosis type one, may undergo malignant transformation. Therefore, the assertion concerning type 2 neurofibromatosis lacks support from their reference. For the sake of clarity, farschtchi et al.3, in their article, also stated that “schwannomas in neurofibromatosis type 2 hardly ever undergo malignant transformation.”In the second paragraph of the discussion section, the authors refer to abdominal Magnetic Resonance Imaging (MRI) as the ”gold standard” for diagnosis, citing Radojkovic et al. 4 and Harhar et al. While Radojkovic et al. do emphasize the role of MRI in diagnosing soft-tissue tumors, it is crucial to clarify that MRI is not universally the gold standard for differentiating between benign and malignant lesions. Moreover, Harhar et al. acknowledge the lack of distinct imaging characteristics for retroperitoneal schwannomas on computed tomography (CT) and MRI scans. Since there is no gold standard diagnostic method for RSs5, establishing a definitive preoperative diagnosis of RSs remains challenging. However, the importance of contrast-enhanced CT as a primary imaging investigation, especially in differentiating various pathologies in the retroperitoneum, should be highlighted, as suggested by Messiou et al.6 in 2018. Despite the availability of numerous advanced imaging techniques, such as ultrasound (US), CT, and MRI, the absence of distinct imaging features limits our ability to diagnose RSs accurately, with less than 20% of all cases receiving a precise preoperative identification. 7Lastly, in the introduction section, the authors state that retroperitoneal schwannomas represent only 4% of all retroperitoneal tumors, citing Radojkovic et al. 2018. 4 However, I would like to point out that this specific reference is not mentioned anywhere in the manuscript. The accurate source for this information is Harhar et al. 2021. This discrepancy in referencing should be addressed and corrected, as the integrity of scientific literature relies on accurate and well-referenced information, especially in clinical case reports.Retroperitoneal schwannomas (RSs) are unusual tumors, accounting for only 1 to 3% of all schwannomas. They often go unnoticed due to the expansive and flexible nature of the retroperitoneal space, leading to delayed diagnosis and significant lesion growth. Definitive diagnosis of schwannomas is based on histopathological and immunohistochemical findings8. Characteristic histopathological changes are marked by elongated spindle cells forming hypercellular Antoni A areas with twisted nuclei and Verocay bodies, as well as hypocellular Antoni B regions exhibiting inflammatory cells, collagen bundles, and xanthomatous changes8,9. The primary treatment approach involves surgical removal, which can be accomplished through traditional open procedures or minimally invasive laparoscopy, often yielding positive therapeutic results5,10. However, this necessitates thorough preoperative planning and a multidisciplinary approach, given the complex nature of both diagnosis and treatment.

Title: Hemoptysis Secondary to Anomalous Origin of Right Pulmonary Artery from Ascending Aorta in a Young Male: A Case Report

With the wide application of vision-based autonomous driving and mobile robots, the impact of frequent sand-dust weather on computer vision applications in landlocked countries during spring and autumn has also attracted more and more attention. Although there has been a lot of research on sand-dust image enhancement, no research has been conducted on how to improve the positioning accuracy of vision-based autonomous driving or mobile robots in sand-dust environments, especially because there is currently a lack of data sets to evaluate visual positioning in sand-dust weather. Therefore, we propose a complete set of visual positioning data set construction methods in sand-dust weather to fill the gap in the evaluation data set of application fields such as autonomous driving or mobile robot attitude estimation in sand-dust weather. At the same time, this method is also suitable for the construction of visual positioning data sets under haze and other similar weather. In addition, this paper further demonstrates to readers how to use the converted dust visual positioning data set to conduct positioning evaluation experiment of automatic driving in sand-dust weather.

In recent years, the dense deployment of small base stations (SBSs) has led to the rising power consumption of mobile networks. In this paper, we introduce a convolutional neural network (CNN) based centralized sleeping control and bandwidth allocation (C-SCBA) scheme for multiple SBSs controlled by a central controller to minimize the total power consumption while satisfying the transmission rate requirements. We formulate the optimization problem as a mixed integer non-linear programming (MINLP) problem, and decouple it into two sub-problems: a centralized bandwidth allocation (CBA) sub-problem that minimizes the power consumption by optimizing the bandwidth allocation of the active SBSs; and a centralized sleeping control (CSC) sub-problem that finds the optimal SBS sleeping strategy among all the possible ones. The CBA sub-problem is transformed into a linear programming (LP) problem which can be directly solved by many existing software tools. For the CSC sub-problem, we transform it to a classification problem and propose CNN to solve it. Simulation results show that the proposed C-SCBA scheme has a near optimal performance in the reduction of total power consumption and satisfying the traffic requirments compared to the existing approaches in different situations.

A fully-clamped graphene/poly(methyl methacrylate) (PMMA) open cavity resonator with fundamental frequency within the lower ultrasonic frequency range (less than 100 kHz) has been fabricated and the dynamic behavior of the graphene/PMMA resonator has been observed and characterized in atmospheric pressure and at room temperature. The challenge in achieving the fundamental frequency less than 100 kHz in resonators made by graphene-based material is the handling of the large size of the thin membrane and the need to modify the fabrication method to prevent collapse of the membrane. In this work, graphene/PMMA membrane consisting of 6-layer graphene and 450 nm poly(methyl methacrylate) (PMMA) has been wet transferred over a square cavity with the side length of 0.5 mm. The resonant frequency has been measured to be around 75 kHz by mechanical actuation and 79 kHz by electro-thermal actuation. The (0,1) mode has been detected to dominate the resonance. The simulated dynamic behavior of the graphene/PMMA membrane over the open cavity has been found to be in agreement with experimental measurements. The strain in the graphene/PMMA membrane has been estimated to be around 0.2 %.

Mixed transition metal oxides with adjustable composition and structures are widely used in electro chemical cell applications such as lithium-ion batteries and supercapacitors their high theoretical capacity, high energy density, high cyclic durability, and environment friendliness compared to mono metal oxides. Different routes like sol gel, combustion, solvothermal, sonication, hydrothermal are used for their synthesis. This chapter gives an overview of some of the key MTMOs in different structural and forms like layer, core-shall, nanorods, nanosheets etc and in the forms of composites with materials like PANI, rGO, CNT, CNF etc

Runoff in natural rivers, commonly termed as streamflow, is a major process in the water cycle and a crucial variable in water resources engineering. While the increase in extreme rainfall events over the Conterminous United States (CONUS) has been well-documented, understanding the variability of streamflow remains challenging due to the nonlinear relationship between rainfall and runoff. In this study, daily streamflow data from 18 USGS gauge stations with the largest drainage area in its respective Hydrologic Unit Code 2-digit (HUC-2) region throughout the CONUS with contiguous records spanning from 2003 to 2022 water years is used to gain insights into streamflow variability over the past two decades. The original Mann-Kendall (MK) Test is employed to assess the potential temporal trends in the basic statistics (maximum, mean, minimum, and standard deviation) of annual streamflow data over the past 20 water years. Additionally, the seasonal MK Test is performed to explore the trends in the same basic statistics of the daily streamflow on a monthly basis. Furthermore, the statistical distributions of the normalized daily streamflow within each decade (2003-2012 and 2013-2022) are compared for each HUC-2 region. The results of the original MK Test indicate that no discernible trend in the annual streamflow and its standard deviation for most of the HUC-2 regions. However, the results of the seasonal MK Test suggest either an increasing or decreasing trend in around 30% of the HUC-2 regions. Moreover, low flows demonstrate a more significant change in frequency compared to high flows between the past two decades. Overall, this study highlights the complexity of the streamflow variability and the potential implications for changes in flood or drought risk under a changing climate.  

Stannic oxide , Sn (IV) O2 synthesized by the sol-gel method showed heterogeneous crystallinity involving traces of stannous oxide, Sn (II) O as well which were studied based on the nucleation sites and aggregation of crystallites. The height to width ratio (HWR) was found to be an effective means of analyzing the growth process which involved lateral atomic diffusion and reversible phase transitions. The crystallinity and aggregation to larger crystallites is beneficial for electron transfer layer (ETL) in perovskite solar cells. The structure and morphology were determined by XRD and SEM-EDAX

The dielectric and optical properties of materials are important when creating biomedical prototypes utilising additive manufacturing or 3D printing. For high-frequency devices, characteristics such as dielectric constant, resistivity, and dielectric loss are used. Piezoelectric materials, such as polymer ceramic composites, have a significant impact on diagnostics and bone healing. 3D printed lenses and other metamaterial-based optical elements are employed in imaging and sensing applications incorporating polarisation and plasmonic characteristics.

Guidelines Knowledge Level 1 (L1) Checklist Our objective is to develop an extension of the widely used GIN-McMaster Guideline Development Checklist and Tool for the Adoption and Implementation of Computable Guidelines. This checklist extension is intended to be used as a tool to help guideline developers develop narrative clinical guidelines with knowledge Level 1 (L1) in clearer, consistent, and more structured approach so that their key information like metadata, evidence, and recommendations may be successfully implemented by informaticists in computable formats used in clinical decision support systems that would improve patient outcomes through evidence-based medical practice in a learning health system based on FAIR (Findable, Accessible, Interoperable, and Reusable) principles. This may cover clinical practice guidelines and their related systematic reviews, evidence reports, and supplementary data and materials.Please provide your comments on the below L1 checklist labeled items on the following link: https://docs.google.com/forms/d/e/1FAIpQLSfZhtHnZ4kAQxXJnGL9bgqlT4o5LCIbRewavLcKzQUPQXKcqg/viewform Applicable to Guideline Developer Applicable to Informaticist/ Implementer Item Label Description Useful Resources/ Examples Further details X* -* 1. Policy Provide a link with a persistent identifier to public documentation of standards used by the organization to develop their guidelines, including the organization’s methods and procedures, including how it established transparency, composes its guideline development group, manages conflicts of interest, and its evidence review, rating of evidence, peer review, update, data management, and distribution/publishing policies. ·       GIN McMaster Checklist ·       IOM Guidance X - 2.Scope Clearly articulate the scope of the guideline development project, including who the guidelines are for, what clinical domains they cover, and where they may be practiced. ·       Adapting Clinical Guidelines for the Digital Age ·       An Integrated Process for Co-Developing and Implementing Written and Computable Clinical Practice Guidelines ·       Integrated Process tables: https://stacks.cdc.gov/view/cdc/131006An Evaluation Framework for a Novel Process to Codevelop Written and Computable Guidelines ·       Evaluation framework tool: https://stacks.cdc.gov/view/cdc/131007 X - 3.Goal(s) Clearly articulate why a guideline development project is needed. X X 4.Contributor(s) Ensure the involvement of informaticists and implementation scientists in the guideline’s development panel. Provide contact information for guideline developers, informaticists, and other involved stewards - X 5.Knowledge Levels Requirements Provide a clear, strong, and tangible definition of the requirements of each guidelines knowledge levels starting with the executable knowledge level 4 (L4) to be able to understand what is needed at L1 and be most useful ·       FHIR Clinical Guidelines (v1.0.0) (STU 1) (hl7.org) X - 6.Guideline Question formulation Formulate measurable and/or observable clinical questions using the Patient/population, Intervention, Comparison, and Outcomes (PICO)      Process ·       Patient/population, Intervention, Comparison, and Outcomes (PICO)      Process X X 7.Guideline Structure Use a consistent GRADE (Grading of Recommendations Assessment, Development and Evaluation) scale that is publicly documented and linked to evidence statements Use a structured, machine-readable format to consistently declare each recommendation and its GRADE ·       JATS4R  ·       GIN McMaster Checklist ·       IOM Guidance ·       EBMonFHIR - Clinical Decision Support - Confluence (hl7.org) ·       Agency for Healthcare Research and Quality (AHRQ) Systematic Review Data Repository (SRDR+) Use the evidence-based structure and requirements for guidelines related systematic reviews, evidence reports, and supplementary data and materials. X X 8.Documentation requirements per recommendation Identify and use common data elements and variables while writing your recommendation in order to implement it in conformance with your real-world requirements and health outcomes.   Formulate guidance for each recommendation using the same necessary data elements, value sets, and measures used to develop them from PICO questions. Understand data to model, define, and map those data elements through the entire learning health system for the particular topic / disease / drug / screening / etc… Consider and formulate the care pathways for implementing each recommendation when there is sufficiently clear evidence to confidently do so.   Clearly articulate possible care options, along with the known variables and contexts using the heuristic theory of decision‐making, often implemented as fast‐and‐frugal (FFT) decision trees since they are linked to signal detection theory, evidence accumulation theory, and a threshold model of decision‐making, which, in turn, allows quantitative analysis of the accuracy of clinical management strategies Use an existing application,  template, or other tool to facilitate the generation of individual statements that can be executed to these algorithms. For example: If (x AND y OR z)  is true: make N recommendation. x, y, z statements should be easy to find within the narrative, and should be documented clearly ·       https://goodwin.libguides.com/c.php?g=309484&p=2066254 ] ·       United States Core Data for Interoperability (USCDI) | Interoperability Standards Advisory (ISA) (healthit.gov) ·       Value Set Authority Center (nih.gov) Additional Resources for International Community: ·       InternationalPatientSummaryIG (hl7.org) ·       International Classification of Health Interventions (ICHI) (who.int) ·       CDS Authoring Tool (ahrq.gov) ·       FHIR Clinical Guidelines (v0.2.0) (Current) (hl7.org) ·       FFT Decision Tree Example Define the data elements and variables that will be used when performing complex queries on available data sets and published literature. X X 9.Guideline Update Guideline developers should have a clear versioning policy for all updates to their evidence and guidance following common version algorithms while taking into consideration the level of incorporated changes Major, Minor, and Patch. Maintain an open, transparent, and continually learning and updated system based on the latest set of evidence available. ·       https://semver.org/ ·       https://www.hl7.org/fhir/valueset-version-algorithm.html Each version shall have a persistent identifier for transparency in the historical record, and that each version can be linked across all other versions of that document through clearly communicated related publications in each document and its indexed metadata. *X: Applicable, -: Not Applicable

Rationale: Diaryliodonium salts are useful electrophilic reagents in organic chemistry, finding extensive applications in arylations and photo-induced polymerizations. However, the comprehensive mechanistic investigations, particularly concerning the mass spectrometric behaviors of diaryliodonium salts, are relatively scarce in the literatures. Methods: Diaryliodonium salts could be readily ionized in ESI-MS to give [Ar 1-I +-Ar 2], and the high-resolution ESI-MS/MS experiments were conducted to investigate their gas-phase chemical reactions. Results: Investigations on ESI-MS/MS of [Ar 1-I +-Ar 2] revealed two major fragmentation patterns: 1) Reductive elimination resulting the diaryl coupling product ion [Ar 1-Ar 2] +• by the loss of I. 2) Generating aryl cations [Ar 1] + or [Ar 2] + through cleavage of the C–I bonds. We unrevealed that the introduction of NO 2 into Ar 2 of [Ar 1-I +-Ar 2] could lead to an unexpected fragmentation ion [Ar 1O] + in MS/MS, arising from an O-atom transfer process from NO 2 to Ar 1. Particularly, when NO 2 was ortho-positioned to the iodine in Ar 2, the [Ar 1O] + sometimes exhibited dominant behavior. Conclusions: Comprehensive ESI-MS/MS studies and theoretical calculations provided strong support for the O-atom transfer mechanistic pathway: [Ar 1-I +-( o-NO 2-Ar 2)] initially underwent a Smiles rearrangement to the intermediate [Ar 1-O-( o-NO-Ar 2I)] +, which subsequently dissociated to [Ar 1O] + or [ o-NO-Ar 2I] +•. Herein, we proposed an unexpected ” ortho-effect” in the gas-phase fragmentation reaction of [Ar 1-I +-( o-NO 2-Ar 2)], in which the crucial determinant factor for the aryl migration was identified as the Smiles rearrangement reaction.

RATIONALE: Urine contains free and conjugated steroids. Total and free steroids were comprehensively quantified; UPLC-MS/MS based on Li adduction allowed for detecting thirteen 3-OH-containing steroids, two of which were detected in human urine for the first time. METHODS: Free urinary steroids were isolated by solid-phase extraction (SPE) with 80% acetonitrile. The total steroids were prepared by enzymatic treatment of urine with a cocktail of sulfatase and glucronidase, protein precipitation, and separation with the above SPE. The free and total steroids were separately analyzed by UPLC-MS/MS with and without introduction of Li + solution. The steroids were quantified by two standard curves created using product ion transitions derived from MH + and [M+Li] +. RESULTS: Two groups of human urine, male and female urine, were analyzed. The absolute amount of each steroid was determined based on creatinine levels. The differences between the male and female groups are clearly attributable to sex steroids. 7-OH P5 and 7-OH DHEA were, for the first time, quantified in the total steroids of female urine, and the latter was identified in both female and male urine. CONCLUSIONS: By combining UPLC-MS/MS based on lithium ion incorporation with conventional UPLC-MS/MS, a total of 29 steroids were identified in human urine containing two newly found steroids.

Research Article

High species diversity in a community may reduce risk of infectious disease, termed the dilution effect. However, the generality of dilution effect in different disease systems remains controversial. Besides host competence, behavior of fish hosts also may play an important role in dilution or amplification of disease. Using the goldfish (Carassius auratus)-Gyrodactylus kobayashii system, effects of host competence and schooling behavior on parasite transmission were investigated while holding focal host density constant. Following competency tests of 12 fish species as potential hosts for the parasite, infection of G. kobayashii was determined on fins of goldfish mixed with each one of three different species based on their level of host competence, including the silver crucian carp, C. auratus gibelio (low competence), the grass carp, Ctenopharyngodon idellus (incompetence), the swordtail Xiphophorus helleri (incompetence), and all four species combined. Compared with mean abundance (85.8 ± 25.1) on goldfish in the control group, there was a significant decrease in the silver crucian carp group (30.0 ± 16.5), but no significant changes in the swordtail group (70.0 ± 22.2), the grass carp group (116.1 ± 33.2), or the multi-species group (75.9 ± 30.8) during the 10-day experiment. The parasite was also found on C. auratus gibelio in the silver crucian carp group and the multi-species group at a mean abundance of 7.1 and 10.9, respectively. Analysis of swimming behavior showed that the goldfish mixed well in schools with the silver crucian carp. However, the goldfish maintained separation from the grass carp and swordtail when mixed together. Distance between goldfish increased, and swimming speed and contact time decreased with the additional fish for all groups. The results suggested that the presence of a low-competence host in sufficient numbers was a necessary condition for a dilution effect due to encounter reduction, and the dilution effect may also be enhanced by changes in schooling behavior of goldfish in the presence of the low competence hosts. However, the presence of incompetent hosts did not result in any dilution effect owing to the specialist nature of the parasites and the lack of mixing with schools of goldfish.

To investigate the intricate relationship between phytoplankton taxonomy composition and functional group structure, and identifying the key environmental drivers of phytoplankton community dynamics, we conducted a comprehensive study encompassing 11 lakes and reservoirs located in North China. Environmental parameters, spanning climato-geographic factors and hydrochemical variables, were comprehensively assessed. Phytoplankton were categorized utilizing both traditional taxonomic criteria and functional group classifications. Our investigation unveiled rich phytoplankton diversity across these 11 water bodies, comprising 81 genera spanning 7 phyla. This taxonomic diversity was further organized into 30 distinct functional groups (FG). Remarkably, when comparing community structures, we observed a high degree of similarity between taxonomic and functional group-based classifications in lakes. Redundancy analysis (RDA) results underscored the pivotal role of climato-geographic factors as dominant drivers influencing both taxonomic composition and functional group distribution. Intriguingly, variance partitioning analysis (VPA) revealed that while climato-geographic factors exerted substantial influence, their impact was eclipsed by hydrochemical factors. The intricate interplay of six environmental parameters emerged as influential through stepwise regression analysis. These included chlorophyll-a (chl-a), Chemical Oxygen Demand (CODMn), Total Phosphorus (TP), Total Nitrogen (TN), Secchi Depth (SD), and Longitudinal Position (LON).

Mountainous grasslands in South America represent highly diverse ecosystems that offer a broad spectrum of benefits to people. These include the regulation and purification of water, prevention of soil erosion, provision of livestock feed, and preservation of cultural heritage. Previous research has underscored the significant role of grazing in shaping the diversity and productivity of grassland ecosystems, particularly in highly productive, eutrophic systems. In such systems, grazing has been demonstrated to restore grassland plant diversity by reducing primary productivity. However, it remains unclear whether these findings are applicable to South American mountainous grasslands, where plants are adapted to different environmental conditions. To address this gap, we conducted a meta-analysis of experiments that excluded livestock grazing. The goal was to quantify the impact of grazing exclusion on plant diversity and productivity across mountainous grasslands in South America. Our findings, akin to studies conducted in temperate grasslands, revealed that herbivore exclusion led to an increase in aboveground biomass. Nevertheless, it also resulted in a reduction in species richness and Shannon diversity. Interestingly, the effects of grazing exclusion became more pronounced with longer exclusion durations, yet remained robust to various climatic conditions, including mean annual precipitation and mean annual temperature, as well as the evolutionary history of grazing. In contrast to results observed in temperate grasslands, the reduction in species richness due to herbivore exclusion was not correlated with increased aboveground biomass. This suggests that the processes regulating (sub)tropical grassland plant diversity may differ from those in temperate grasslands. Further research is imperative to better comprehend the specific factors influencing plant diversity and productivity in South American montane grasslands and to discern the ecological implications of herbivore exclusion in these unique ecosystems..

Vascular smooth muscle cell (vSMC) dysfunction is a critical contributor to cardiovascular diseases, including atherosclerosis, restenosis, and vein graft failure. Recent advances have unveiled a fascinating breadth of non-coding RNAs (ncRNAs) that play a pivotal role in regulating vSMC function. This review aims to provide an in-depth analysis of the mechanisms underlying vSMC dysfunction and the therapeutic potential of various ncRNAs in mitigating this dysfunction, either preventing or reversing it. We explore the intricate interplay of microRNAs, long-non-coding RNAs and circular RNAs, shedding light on their roles in regulating key signalling pathways associated with vSMC dysfunction. Moreover, we discuss the prospects and challenges associated with developing ncRNA based therapies for this prevalent cardiovascular pathology.

A document by Suresh Kumar Mahala. Click on the document to view its contents.

The study of segmenting breast lesions from ultrasound images is crucial to breast cancer diagnosis and treatment. In this study, we propose the Inception-Multi-Scale-Attention U-Net (IMSA-Net) method to address the challenges associated with breast cancer imaging artifacts, tumor morphological alterations, and blurred borders. The IMSA-Net method incorporates the inception module into the downsampling feature extraction section of the U-Net model. This can extract advanced features from the input image and enhance the model’s capability to express complex features. Furthermore, during the feature fusion stage, a multi-scale attention structure is introduced to focus on capturing detailed information during the segmentation process. This enhancement contributes to improving the precision of the segmentation results. To enhance the algorithm’s non-linear factor and mitigate the gradient disappearance problem during training, the Gaussian Error Linear Unit (GELU) activation function is employed, replacing the traditional Rectified Linear Unit (ReLU) activation function. This modification allows for better feature representation and overall model performance. The experimental results demonstrate that the IMSA-Net model’s evaluation metrics of mIoU, Dice, Acc, Precision, and Recall on the breast ultrasound images dataset reached 74.18%, 77.98%, 96.86%, 89.23%, and 66.68%, respectively. These results outperform those of the U-Net model by 2.41%, 2.81%, 0.09%, 0.06%, and 2.82%. Overall, the IMSA-Net method tackles the difficulties related to breast lesion segmentation, assisting in subsequent breast disease diagnosis.

n/a per BJOG Research Letter submission guidelines. + happy to submit an abstract if needed. https://obgyn.onlinelibrary.wiley.com/hub/journal/14710528/preparing-your-manuscripts

Background: 6-Mercaptopurine is a cornerstone of maintenance therapy for pediatric ALL. Response to 6MP is typically determined by the ANC. Therapeutic ANC range while receiving 6MP is between 500-1,500/µL. In addition to desired myelosuppression, 6MP is associated with multiple adverse drug effects. Increased doses of 6MP can lead to therapeutic ANC values; however, patients may experience adverse effects before obtaining therapeutic myelosuppression, often deemed “skewed metabolism.” Allopurinol may potentially correct skewed 6MP metabolism. Procedure: Pediatric patients with ALL with 6MMP and 6TGN metabolites drawn during maintenance therapy were analyzed for allopurinol use. The primary outcome evaluated the percentage of time spent in therapeutic ANC range before and after allopurinol initiation. Additionally, the difference in 6MMP:6TGN ratios before and after allopurinol initiation, incidence of hepatotoxicity, and rates of relapse, were analyzed. Results: Ninety-five patients were included for analysis. Thirty-two (34%) patients received allopurinol. There were no significant differences in baseline demographics between the patients who received allopurinol and those who did not. When comparing ANC values pre- and post- allopurinol initiation, a statistically significant increase in the percentage of time spent in therapeutic range was observed (27% vs. 43%; P=0.03). Additionally, when comparing metabolite ratios pre- and post-allopurinol initiation, a statistically significant decrease in 6MMP:6TGN metabolite ratio values was observed (86.7 vs 3.6; P < 0.0001). Conclusions: Allopurinol significantly increased the percent time in therapeutic ANC range and can be safely utilized to significantly lower the ratio of 6MMP:6TGN metabolites, alleviating the undesirable side effects of 6MMP, and optimizing the anti-leukemic effects associated with 6TGN.