Introduction: Atrial fibrillation (AF) is the most common form of sustained cardiac arrhythmia, characterized by irregular R–R intervals and the absence of distinct P waves with irregular atrial activity (also known as fibrillatory waves). C-reactive protein (CRP), a marker of systemic inflammation, has been implicated in various cardiovascular diseases, including AF. Neutrophil-to-lymphocyte ratio (NLR) reflects the balance between innate and adaptive immunity and has emerged as a potential prognostic marker in cardiovascular conditions. Despite extensive research on AF, the existing literature predominantly focuses on individuals of white ethnicity. Therefore, further investigation is needed, particularly in diverse ethnic populations. To address this gap, this study utilized a Korean hospital database to explore the relationship between AF and two inflammatory markers: CRP and NLR. Methods: A retrospective cohort study was conducted on 164 patients, equally divided between AF and NSR groups. CRP levels and NLR were measured using standard assays, and ECG data confirmed AF diagnosis. Statistical analysis, including ROC cuve evaluation, was performed to assess the discriminatory power of these biomarkers. Results: Analysis of the study data revealed a significant difference in CRP levels between AF patients and those with normal sinus rhythm, indicating a pronounced inflammatory response associated with AF. However, NLR did not exhibit a substantial difference between the two groups. Conclusion: CRP may serve as a reliable biomarker for detecting inflammation in patients with AF, whereas NLR may not be as discriminatory in this patient population.

Background and Purpose: The cannabinoid type 2 receptors (CB2R) represent a target of increasing importance in neuroimaging due to its upregulation under various neuropathological conditions. Previous evaluation of [18F]JHU94620 for the non-invasive assessment of the CB2R availability by positron emission tomography (PET) revealed favourable binding properties and brain uptake, however rapid metabolism, and generation of brain-penetrating radiometabolites have been its main limitations. To reduce the bias of CB2R quantification by blood-brain barrier (BBB)-penetrating radiometabolites, we aimed to improve the metabolic stability by developing d4 and -d8 deuterated isotopologues of [18F]JHU94620. Experimental Approach: [18F]JHU94620-d8 was further evaluated to characterize its binding properties, metabolic stability, formation of BBB-penetrant radiometabolites and biodistribution in mice and rats. Key Results: The deuterated [18F]JHU94620 isotopologues showed improved metabolic stability avoiding the accumulation of BBB-penetrating radiometabolites in the brain over time. CB2R-specific binding with KD values in the low nanomolar range was determined across species. Dynamic PET studies revealed a CB2R-specific and reversible uptake of [18F]JHU94620-d8 in the spleen and to a local hCB2R(D80N) protein overexpression in the striatal region in rats. Conclusion and Implications: These results support further investigations of [18F]JHU94620-d8 in pathological models and tissues with a CB2R overexpression as a prerequisite for clinical translation.

From the initial cloning of animal-salamander to the first cloning of primate-monkey, nuclear transfer research spans a substantial history of 96 years. Throughout this nearly century-long research journey, it has not only tackled a range of significant scientific questions but has also found applications in various practical contexts. In this context, I offer a comprehensive overview of the developmental history, practical applications, and present status of nuclear transfer research.

Aim Islands species are vulnerable to human impacts and extinction. Consequently, many islands’ species have been extirpated, causing complete or local extinctions. Reintroductions are useful, although challenging, tools to restore ecosystems. In this work, we evaluate the reintroduction success of the endemic white-tailed laurel pigeon (Columba junoniae) on the island of Gran Canaria. We also explore its future potential distribution under different scenarios of climate change. Location Canary Islands, Spain Methods We used a combination of Maximum Entropy models (MaxEnt) to model the potential niche of C. junoniae in the whole Canarian archipelago, including its new distribution area. We compare this potential distribution with the actual distribution of the species in the reintroduction area. Furthermore, we used multiple scenarios of climate change to analyse the likely changes in the species’ suitable habitat. Results We found that C. junoniae has colonised most of its potential habitat in the new reintroduction area. Overall, this marks that the reintroduction has successfully facilitated the distribution and settlement of the species. However, our analysis also showed that this habitat is expected to suffer future fragmentations and contractions under different climate change scenarios. Main Conclusions Based on our research, C. junoniae has colonized most of its potential habitat within its new distribution area. Although this is a huge milestone for the conservation of the species, future changes might jeopardize the species’ future. In this scenario, microhabitats and refugees can alleviate this situation. Our results also suggest that restoration of native forests is fundamental to ensure the species’ long-term persistence and ecosystems’ resilience against climate and land-use changes. This work set the principles for the evaluation and long-term planning for the reintroduction of C. junoniae in Gran Canaria.

Biodiversity offers diverse ecosystem services responsible for increasing human well-being and moving financial capital around the world. Therefore, given the natural and human causes of biodiversity reduction, we need to use computational methods that not only show where to find high species richness, or phylogenetic and functional diversity, but also low economic cost or even high originality or distinctiveness. In this paper, we introduce a new package (‘bivariatemaps’) with methods to prioritize areas, communities or species on a large scale, and we show an example for finding the best areas for the conservation of terrestrial and flying mammals (endothermics) and the Serpentes (ectothermics). We do that by finding high potential for providing ecosystem services (measured here by Species Richness) and correlating it with Economic Cost (measured as Land Acquisition Cost). Additionally, we correlated NDVI (Normalized Difference Vegetation Index) with Economic Cost, to observe how we could maximize productivity while reducing resource usage as much as possible. To achieve this goal, we first developed the ‘bivariatemaps’ package, using it to plot bivariate maps that integrate the Species Richness with the Land Cost for each of the three studied groups. We observe that more attention should be paid to tropical countries, which have high species richness, but low land acquisition cost. We note that more attention should be paid to the Indomalayan region, which has a high richness of species low-cost sites for the conservation of species. Bivariate maps have been published in studies since the 70s, but only in the 2010s they became more used by the general public, including scientists from low-profit universities. We hope that this paper (and the ‘bivariatemaps’ package) helps to generate works planned globally and regionally in the face of natural and anthropogenic processes responsible for the loss of biodiversity that can bring us socio-economic benefits.

1. Understanding animal cognition and choice behaviour is a fundamental goal in many fields of biology and ecology. Because many aspects underlying behaviour and cognition are not directly observable, formal theoretical and statistical modelling is required. We propose the use of a Bayesian Hierarchical Model (BHM) to analyse the preferences of six semi-tame African elephants (Loxodonta africana) over a variety of fruit rewards that might be used in future tasks. Bayesian models use hierarchical priors based on pooled behaviour over all elephants to make informed inferences about the cognitive processes generating the observed behaviour of individual animals. Using hierarchical priors allows us to make robust inferences about individual elephants without the need for extensive individual observations. 2. The theoretical model underlying the statistical model here proposed is widely used in social sciences. It posits that each elephant makes binary choices over fruit types to maximize the random utility that the individual attaches to each fruit. These random utilities are used to determine the probabilities of choice of one fruit or another. 3. We found that the elephants had similar likes and dislikes for the fruits considered, but they exhibited considerable heterogeneity in the strengths of their fruit preferences. For example, apples and mangos were generally preferred over the alternatives, but when comparing apples vs oranges, apples were slightly preferred by two elephants and oranges were strongly preferred by other two. It is crucial to draw robust inferences about individual animal preferences when conducting experiments involving individual choices, such as the elicitation of elephant risk preference, the final aim of our project. 4. Our case study demonstrated that the use of Bayesian hierarchical models coupled with controlled experimental choice data, can provide rich insights into animal cognition processes and behaviour, particularly when focusing on the level of the individual animal.

Ongoing and predicted range loss of kelp forests in response to climatic stressors are pressing marine managers to look into the adaptive capacity of populations to inform conservation strategies. Characterising how adaptive genetic diversity and structure relate to present and future environmental variation represents an emerging approach to quantifying kelp vulnerability to environmental change and identifying which populations have the genetic material to handle future ocean conditions. The dominant Australian kelp, Ecklonia radiata, was genotyped from 10 locations spanning 2,000 km of coastline and a 9.5°C average temperature gradient, along the east coast of Australia, a global warming hotspot. ddRAD sequencing was used to generate 10,700 high quality single nucleotide polymorphisms (SNPs) and characterize levels of neutral and adaptive genomic diversity and structure. The adaptive dataset, reflecting portions of genome putatively under selection, was used to infer genomic vulnerability by 2050 under the RCP 8.5 scenario. There was strong neutral genetic differentiation between Australia mainland and Tasmania, but only weak genetic structure among mainland populations within the main path of the East Australian Current. Genetic diversity was highest in the centre of the range, and lowest in the warm-edge population. The adaptive SNP candidates revealed similar genetic structure patterns with a spread of adaptive loci across most warm (northern) populations. The lowest, but most unique, adaptive genetic diversity values were found in both warm and cool population edges, indicating local adaptation but low evolutionary potential. Critically, genomic vulnerability modelling identified high levels of vulnerability to future environmental conditions in Tasmania. Populations of kelp at range edges are unlikely to adapt and keep pace with predicted climate change. Ensuring the persistence of these kelp forests, by boosting resilience to climate change, may require active management strategies with assisted adaptation in warm-edge (northern) populations and assisted gene flow in cool-edge (Tasmania) populations.

Cardiac calcific amorphous tumor (CAT) is a rare non-neoplastic, intra-cavitary cardiac tumor commonly associated with mitral annular calcification (MAC). Rates and rapidity of recurrence of CAT are not well documented in the current literature. We present a case of MAC-related CAT presenting initially as an embolic stroke with suspected rapid recurrence within two months following initial excision. Given the rapid recurrence in this case, it may be necessary to reconsider the therapeutic approach to MAC-related CAT, with stronger consideration of mitral valve debridement and replacement. A multi-disciplinary approach with patient involvement is required for the best treatment in these cases.

Background: Lipid Transfer Protein (LTP) is often diagnosed using a combination of clinical history, skin tests and laboratory tests. The peach LTP allergen Pru p 3 is considered a reliable marker of sensitisation to LTP but does not discriminate between allergy and sensitisation alone. Methods: We retrospectively reviewed the results of adult patients referred for a suspected food allergy to the Allergy Unit at the Royal Brompton & Harefield NHS Foundation Trust (RBHT) London (UK), between 2012-2022 who were sensitised to Pru p 3. Those with a final diagnosis of LTP allergy, were compared to those sensitized to Pru p 3 but not diagnosed with LTP allergy. Results: Of 285 patients with a positive Pru p 3, 157 (55%) were diagnosed with LTP allergy. LTP allergic patients were more likely to have a higher level of Pru p 3, a lower level of total IgE and a positive skin prick test to peach extract (p<0.001). The ratio of Pru p 3 to total IgE was the most accurate diagnostic marker of LTP allergy in those sensitized to Pru p 3, with a ROC AUC of 0.880. A diagnosis of LTP allergy was significantly associated with sensitisation to the LTP in peanut (Ara h 9, p<0.001), and hazelnut (Cor a 8, p<0.001). Conclusion: Although a range of allergy tests may contribute to the diagnostic workup, the Pru p 3 sIgE:total IgE ratio could be a more effective way of discriminating between sensitization to Pru p 3 and true LTP allergy.

The growing complexity of oncology care necessitates a collaborative and comprehensive approach to improve patient outcomes. Hospitalists, as integral members of the healthcare team, play a pivotal role in enhancing oncology care through early detection, multidisciplinary collaboration, and comprehensive management of cancer patients. By fostering communication between oncologists, primary care providers, and ancillary services, hospitalists enhance treatment continuity and patient satisfaction. Additionally, their expertise in managing comorbidities and addressing psychosocial aspects of cancer care is crucial for optimizing patient outcomes. Through a detailed examination of existing literature and clinical practices, this article underscores the importance of hospitalists in oncology, advocating for their expanded role in delivering holistic and patient-centered care that ultimately leads to improved survival rates and quality of life for cancer patients.

A document by süleyman gökmen. Click on the document to view its contents.

Background Fractional exhaled nitric oxide has been used as a marker of airway inflammation. The concentration of nitric oxide in the central and peripheral airway can be measured by different exhalation flow rates to evaluate inflammation in different divisions within the respiratory tract. We hypothesized that fractional exhaled nitric oxide could be used as an evaluation tool for airway inflammation in different allergic types of pediatric asthma. Methods We recruited 487 subjects into the study: 238 children with single inhalant allergic asthma, 36 children with single food allergic asthma, 181 children with mixed allergic asthma, and 32 allergen-negative controls. Fractional exhaled nitric oxide including FeNO50 (exhaled NO at a flow rate of 50mL/s), FeNO200 and CaNO (peripheral concentration of NO) were measured among the recruited participants. We compared the differences of fractional exhaled nitric oxide levels between the groups. Results Differences in the concentration of FeNO50 and FeNO200 between various groups were statistically significant (P<0.001). CaNO could not differentiate the allergen-negative group from allergic groups (P>0.05). The concentration of FeNO50 and FeNO200 were significantly higher in the inhalation group and the mixed group than in the food group and controls(P<0.05). The concentration of CaNO was higher in the inhalation group and mixed group than in the food group among the children with well-controlled asthma (P<0.05). Conclusions The concentration of FeNO50 and FeNO200 were significantly elevated in children with inhalant and mixed allergic asthma, which suggests these children have more serious airway inflammation. Therefore, fractional exhaled nitric oxide better reflects and monitors the severity of airway inflammation in children with inhalant allergy and mixed allergy asthma. It could be a guide for adjusting diagnostic and therapeutic strategies.

Assessment of phrenic nerve pacers in a patient with Congenital Central Hypoventilation SyndromeTo the Editor:A 13-year-old patient with Congenital Central Hypoventilation Syndrome (CCHS) was transported to the emergency department following an unwitnessed syncopal event with associated cyanosis. She opened her eyes within a few minutes, her mental status returned to normal, and her oxygen saturation increased back to above 95%. Her parents reported she’s had two or three similar events over the past few months. She was born at 38-week gestation with recurrent central apnea noted immediately after birth. Genetic tests revealed that she was heterozygous for a 36 base pair duplication from nucleotide 729 to 764 of the PHOX2B gene (c 729_764dup36), which encodes an additional 12 alanine residues in the polyalanine tract of the PHOX2B protein (p.Ala244_Ala255dup12). With confirmation of a diagnosis of CCHS1, a tracheotomy was performed, and she was discharged home on positive pressure ventilation. By the end of her first year of life, she was able to be weaned to just mechanical ventilation when sleepy or asleep. At 5 years of age, bilateral phrenic nerve pacers were implanted, and she was successfully decannulated and transitioned from positive to negative pressure ventilation (Avery Diaphragm Pacing System, Avery Biomedical Devices, Inc, Commack, NY. At 7 years of age, she was diagnosed with absence epilepsy and placed on levetiracetam with resolution of her seizures. At 8 years of age, prolonged sinus pauses of up to 6 seconds were documented by an implantable loop recorder, and a cardiac pacemaker was implanted.Vital signs and physical examination in the ED were unremarkable, and neuro, cardiology, and pulmonary consults were obtained. There were no signs of infection; chest x-ray and electroencephalogram were unremarkable. Her cardiac pacemaker was interrogated, and there was no evidence that her cardiac pacemaker had been activated before, during, or after her syncopal episode. A 12-lead electrocardiogram (EKG) was obtained (figure 1). This EKG suggests her phrenic nerve pacemakers are functioning normally, with a set rate of 17 breaths per minute. Approximately every 3.5 seconds, 27 electrical pulses over 1.32 seconds are noted, particularly well seen on leads II, III, aVR, aVL, aVF, and V3-V6. Iron deficiency was noted, and it was subsequently confirmed that she suffered from menorrhagia. Her syncopal episode was judged most likely vasovagal in origin, exacerbated by iron deficiency anemia. Realizing the noteworthy aspects of the case, informed consent was obtained from the patient and her family to publish this case report. This case report is exempt from IRB approval by the New York Medical College Institutional Review Board as per the policy in their manual, “If case reports are not identifiable, there is no need…to contact or to submit any documents to the IRB”.Following the seminal work of Glenn WL, et al 2, diaphragmatic pacing has been utilized in patients with spinal cord injuries or patients with amyotrophic lateral sclerosis3. Some patients with CCHS are being transitioned to ventilation with phrenic nerve pacers, thus permitting tracheostomy closure4.Syncope is not uncommon in patients with congenital central hypoventilation syndrome. Patients with CCHS are at risk for life-threatening cardiac arrhythmia and may sometimes require cardiac pacemakers. Patients being ventilated with phrenic nerve pacers without a tracheostomy, are also at risk for obstructive sleep apnea. Patients with CCHS are prone to fainting, and tilt-table testing confirms they are prone to greater orthostatic decreases in blood pressure than healthy control patients.The artefact due to phrenic nerve pacer discharge in figure 1 has been previously demonstrated in the literature. In 1987, Auerbach and Dobelle reported trans telephonic monitoring of patients with implanted neurostimulators, including a similar figure to ours, using 2 EKG leads5. A similar figure was published in a case report of a patient who developed ventricular tachycardia and cardiac arrest during diaphragmatic pacing, and on polysomnography in a patient with CCHS.In conclusion, a routine EKG may be an easy and quick way to determine if phrenic nerve pacers are functioning properly. Both the frequency and amplitude of phrenic nerve stimulation can be estimated on an EKG.

Migratory species are acutely vulnerable to habitat loss, especially for migratory birds that rely on multiple stopover sites during migration. Typically, migratory birds show less exploratory behavior as they age, i.e., their migration routes typically become more fixed, which leads to higher vulnerability to habitat change. Indeed, due to habitat loss and land use changes in the East Asian-Australasian Flyway, most waterbird populations have rapidly declined, but there are some notable exceptions. We hypothesized that species with stable or growing population may be those able to maintain migration behavioral flexibility into adulthood, enabling them to cope better with environmental change. To test this hypothesis, we used satellite tracking technology to monitor the movement behaviors of Pied Avocets Recurvirostra avosetta, an increasing species highly adapted to artificial wetlands in the East Asian-Australasian Flyway. We compared the migration behaviors of 48 adult and 20 juvenile Pied Avocets in eastern China. In the first two years of life, Pied Avocets performed relatively limited movements. In contrast, some adults migrated to much more southerly wintering grounds or more northerly breeding sites, and occasionally pioneered entirely new flight paths. Additionally, adult birds showed greater variability in their movements during the non-migration period, indicating that older individuals retain behavioral flexibility, likely in response to environmental changes. This suggests that flexible migration strategies in adult animals may enhance resilience to habitat alterations and might help predict which species will be especially vulnerable to environmental change.

Obtaining temporal biodiversity trends in the light of rapid global change is crucial to estimating future impacts – yet the lack of temporally replicated monitoring data limits our ability. Here, we identify imprints of temporal change in static data and utilize them to predict temporal biodiversity trends without requiring a time-series. We used data from temporally replicated breeding bird atlases from four regions worldwide and measured the change in each bird species by log ratio of occupancy change (measure of loss or gain) and by temporal Jaccard index (measure of turnover of sites). We calculated predictors from the configuration of each species’ spatial distribution, traits, diversity metrics, and from study region characteristics and used machine-learning to link these to the temporal change. Static predictors failed to predict the log ratio of occupancy change, but they did predict the magnitude of site turnover. Variables that characterize the spatial configuration of the species range were sufficient to predict the change, while all others contributed only marginally. Here, we show that static data, especially the details of the spatial configuration of species ranges, provide signals of the processes of temporal change. This holds promise for estimating biodiversity change in situations without temporal data.

Requirements are the key to the development of every software product. Resource Description Framework (RDF) systems, propelled by the rise of Linked Data, have necessitated the development of nonrelational models for web-based representation of diverse and incomplete data. As a new and emerging storage format for Linked Data, it requires specialised data management systems for storage and querying purposes. This has led to several RDF engines. It is seen that RDF engine development lacks the proper requirement engineering models. RDF engines also have requirements of storage, reproducibility, scalability, etc., also known as non-functional requirements (NFRs). In the case of the development of traditional software, these NFRs are well understood and established. However, in RDF engines, much of the existing knowledge regarding NFRs is not much applicable. The ever-increasing RDF-based data has caused a shift in the application of NFRs. The idea and interpretations of NFRs in an RDF-based data context (e.g. storage, scalability, reproducibility, etc.) must be rethought. By reviewing case studies from traditional software development, the paper identifies the challenges in adapting these NFRs to RDF engines and proposes research directions to address them. Putting emphasis on the need for specialised data management systems, the paper outlines trade-offs among different NFRs in the RDF domain.

Postage stamps have always functioned as more than just tools for sending letters to others; they are little but powerful ways to convey a nation’s value, history and outstanding achievements(Rajasoorya, 2020). From the start of using postage stamps, numerous nations have used postage stamps to raise awareness about important events, scientific achievements, cultural icons and societal issues. A prominent topic in contemporary philately is healthcare achievement, which commemorates scientific milestones and helps create public awareness about different health issues. In February 2020, the Australia Post Office published a postage stamp on the Human Papillomavirus (HPV) vaccination. It is one of the perfect examples of public health messaging and medical breakthroughs by publishing a postage stamp.

It is well established that heterogeneities in host susceptibility and infectiousness affect transmission, and are typically assumed to be pre-determined traits. However, they may arise dynamically during the transmission process. Specifically, while infectiousness may be an inherent trait of the recipient (‘recipient-dependent’), it may instead be determined by the donor host that infected them (‘donor-dependent’). We investigated how the effects of heterogeneities on transmission are affected by these contrasting scenarios by analysing two ‘Susceptible-Infected’ models for three metrics: the basic reproduction number (R0), changes in heterogeneity, and equilibrium host abundance. We show that the primary driver of R0 differs between the two scenarios: covariance between susceptibility and infectiousness for recipient-dependent, versus maximum infectiousness for donor-dependent. Consequences for equilibrium host abundance also differed, but changes in heterogeneity did not. Our results show that these scenarios change epidemiological dynamics and should be considered when exploring the consequences of host heterogeneity on transmission.

The extensive afforestation efforts on the Loess Plateau, incurring hundreds of billions of CNY, trigger heightened vegetation cover, depleting soil water, and imperiling ecosystem sustainability. Widespread debate persists over the feasibility and optimal locations for afforestation. However, what has been overlooked is the potential presence of alternative stable states within ecosystems, a captivating system equilibrium behavior. This study integrates remote sensing, minimal model, and environmental data to investigate the equilibrium behavior (quantified by tree cover) of forest ecosystems on the Loess Plateau and its implications. The findings suggest a threshold relationship between tree cover and annual precipitation, with a significant increase observed up to 400 mm. Beyond this threshold, alternative stable states emerge, characterized by high tree cover (forest, >35%) and medium tree cover (open woodland, 7%~35%). The equilibrium behavior of the forest ecosystem combines thresholds and alternative stable states. Increasing spatial heterogeneity, especially the positive feedback between vegetation and precipitation, results in advancing transition thresholds with higher annual precipitation. Regime shifts from forest to open woodland increase carbon stock but decrease water yield, revealing a trade-off between carbon sequestration and water resources. This nuanced understanding of equilibrium enhances both theoretical comprehension and practical planning for afforestation on the Loess Plateau, promoting the functions and services of the forest ecosystem.

Dyshidrosiform Bullous Pemphigoid with Dermatophyte infection: An association or coincidence? Diagnostic challenge of a case and review of literatureKeywords: Dyshidrosiform Bullous Pemphigoid; Heart disease; Dermatophyte infection

Primary membranous nephropathy (PMN) is a leading cause of nephrotic syndrome in adults, often progressing to end-stage renal disease (ESRD). While glucocorticoids (GCs) combined with immunosuppressants are commonly used, their comparative efficacy and safety remain unclear. This network meta-analysis aimed to evaluate the efficacy and safety of various GC-immunosuppressant combinations in PMN treatment, conducted following PRISMA guidelines. Databases including PubMed, Embase, and Web of Science were searched up to September 2024. Primary outcomes were 24-hour urinary protein (24hUTP), serum creatinine (SCr), remission rates (CR, PR, TR), relapse, and infection rates. Effect sizes were expressed as standardized mean differences (SMD) and odds ratios (OR) with 95% credible intervals (CrIs). Twenty-four RCTs involving 1403 PMN patients were included. The combination of GCs+rituximab (GCs+RTX) significantly reduced 24hUTP (SMD = -1.17; 95% CrI: -2.32 to -0.03) and ranked highest in reducing SCr (SMD = -1.63; 95% CrI: -3.15 to -0.11). GCs+cyclophosphamide (GCs+CYC) showed the highest remission rates (CR: OR = 3.48; 95% CrI: 1.19 to 10.20) and consistently reduced relapse. GCs+cyclosporine (GCs+CsA) had the lowest infection risk (OR = 0.69; 95% CrI: 0.48 to 1.02). GCs+RTX demonstrated superior efficacy in reducing proteinuria and preserving renal function, while GCs+CYC was most effective in achieving remission and preventing relapse. GCs+CsA had the best safety profile with regard to infection risk. These findings suggest that treatment decisions should consider both efficacy and safety profiles to optimize outcomes for PMN patients.

Introduction Hepatoblastoma has a low annual incidence (1.7/1,000,000 children) posing a barrier to studying epidemiologic risk factors in its development. Current accepted associations include low birthweight and overgrowth syndromes. Neonatal intensive care unit (NICU) interventions were evaluated for the relationship with subsequent development of hepatoblastoma. Methods Pediatric Health Information System data between 2016-2022 was queried for all NICU admissions. From this set, patients with a diagnosis code for hepatoblastoma were identified. Pharmacy billing information was used to calculate total number of days of total parenteral nutrition (TPN) and mechanical ventilation exposure during NICU hospitalization. Results 293,681 patients met inclusion, with 51 patients diagnosed with hepatoblastoma. Logistic regression demonstrated that every 10 additional days of TPN (OR 1.10, 95% CI 1.00-1.13) or mechanical ventilation (OR 1.08, 95% CI 1.06-1.09) was correlated with increased likelihood of development of hepatoblastoma. The dataset was partitioned into two samples, one for training and the other for validation. TPN and duration of mechanical ventilation were the retained predictors within the training sample following least absolute shrinkage and selection operator analysis. Using these retained predictors within the validation sample, there were 773 patients with a predicted probability of developing hepatoblastoma greater than 0.05%, with 6 patients who developed hepatoblastoma (0.78%). Discussion A cohort of infants were identified as having a risk for the subsequent development of hepatoblastoma, similar to that of patient with known associated syndromes. A predictive model was created to assist in identifying patients who may benefit from screening based upon specific NICU exposures.

Background: Chronically transfused patients such as sickle cell disease (SCD) and beta thalassemia major (TM) develop iron overload. Objective: Determine the significance of pancreatic iron in SCD. Methods: Prospective study of 28 SCD and 40 TM patients who underwent research MRIs with liver and pancreas R2*. Patients with normal fasting glucose underwent oral glucose tolerance test. Results: Impaired fasting glucose (2 vs 9, p=0.27) and impaired glucose tolerance (1 vs 11, p=0.019) were less common in SCD compared with TM patients. No SCD patient had diabetes. Conclusion: 22% had significant pancreatic iron, with 1/3 of those having impaired fasting glucose.

A document by Abdalwhab Mohammed Ahmed Abdalla. Click on the document to view its contents.