Nutritious and safe foods are essential to meet normal physiological and metabolic functions. This study evaluated heavy metals in selected food products for newborns and toddlers. These substances may result in adverse health risks and young children are extremely vulnerable due to their immature immune systems and organs. Industrialization and technological advancement have contributed to an increase in heavy metals in the soil; therefore, entering the food system in potentially harmful amounts. Safe levels have been established by monitoring agencies to reduce the presence of heavy metals. Ten national brands of baby foods were analyzed for selected heavy metals. The main ingredients ranged from vegetables, fruits, dairy, poultry, meats, and grains. The products were analyzed in triplicates using QQQ-ICP-MS instrumentation to detect the presence of arsenic, cadmium, zinc, lead, nickel, aluminum, and chromium. Based on the Agency for Toxic Substances and Disease Registry [1] guidelines for safe quantities, aluminum (4.09 µg/g and 2.50 µg/g) and zinc (33.5 µg/g 69.5 µg/g, and 30.2 µg/g) exceeded the recommended levels of 1 µg/g/day and 2 - 3 µg/g /day respectively. Mixed model analysis found significant differences in metal concentrations (F6,24 = 2.75, p = 0.03) with an average metal concentration of 0.96 µg/g. However, no significant correlations were found between the packaging materials used and the observed metal concentrations in the food samples. The study concluded that the presence of heavy metals may be due to food type and the soil on which it is grown and not the packaging materials, establishing food system contamination by heavy metals.

Background: Cesarean section at the second stage of labor occurs when the mother requires delivery with full dilatation of the cervix by cesarean section (CS), which poses a risk to the mother and fetus.Purpose: To study the maternal and fetal outcomes of second-stage cesarean section. Methods: This comparative study was conducted at Alhasahisa Teaching Hospital from August 2021 to January 2022. The study sample comprised 226 women who fulfilled the inclusion criteria, including 113 who delivered by second-stage cesarean section and 113 who delivered by first-stage labor cesarean section as controls. Data were collected using a questionnaire filled out by doctors after informed consent was obtained. Results: The common indications in women who delivered via second-stage cesarean section were fetal distress in 62(51.9%), obstructed labor in 26(23%), and failure to progress in 25(22.1%). In women who underwent first-stage cesarean section, the common indications were failure to progress in 85(75.2%), fetal distress in 16(14.2%), and chorioamnionitis in 12(10.6%) (p < 0.05).  The reported maternal complications in women who underwent second-stage cesarean section were postpartum hemorrhage in 34(30.1%), sepsis in 11(9.7%), prolonged labor in eight (7.1%), extended tears in four (3.5%), umbilical cord prolapse in three (2.7%), and episiotomy in three (2.7%). The admission to the neonatal intensive care unit (NICU) and the causes of admission were more common among the babies of the women delivered by second-stage cesarean section than the babies of the women delivered by first-stage cesarean section (p value < 0.05). Maternal complications in women who underwent second-stage cesarean section included postpartum hemorrhage in 34(30.1%), sepsis in 11(9.7%), prolonged labor in 8(7.1%), uterine extension in 4(3.5%), umbilical cord prolapse in 3(2.7%), and episiotomy in 3(2.7%) (p < 0.05).Conclusion: Second-stage labor cesarean section showed more complications of postpartum hemorrhage, sepsis, and extended tears, as well as more fetal complications, such as admission to the neonatal intensive care unit, fresh stillbirths, low Apgar scores, and birth asphyxia.

Mesenchymal Stromal/Stem Cells (MSCs); which can be isolated from Bone Marrow (BM) in addition to several tissues and body fluids; have the following characteristic features: self-renewal, differentiation into various cell types, plastic adherence, and specific surface markers on flow cytometry [1-3]. 

Remote sensing methods are receiving more and more attention during vegetation studies, thanks to the rapid development of drones. The use of indices created using different bands of the electromagnetic spectrum is currently a common practice in agriculture e.g. normalized vegetation index (NDVI), for which, in addition to the red (R), green (G) and blue (B) bands, in different infrared (IR) ranges used bands are used. In addition, there are many indices in the literature that can only be calculated from the red, green, blue (RGB) bands and are used for different purposes. The aim of our work was to objectively compare and group the RGB indices found in the literature (37 pcs) using an objective mathematical method (structured similarity index; SSIM), as a result of which we classified the individual RGB indices into groups that give the same result. To do this, we calculated the 37 RGB indexes on a test image, and then compared the resulting images in pairs using the structural similarity index method. As a result, 28 of the 37 indexes examined could be narrowed down to 7 groups - that is, the indexes belonging to the groups are the same - while the remaining 9 indexes showed no similarity with any other index.

Animals are companions that have continued to hold importance in the average American household. Traditional animals like dogs and cats are often treated as family members due to the human-animal bond. Although it seems as if there are many benefits to having animals in the home, it comes at a price—pet-borne illnesses. Compared to adults, the pediatric population is at a greater risk for these types of illnesses. Animals are natural reservoirs for many bacteria that may be passed to children, especially those who are immunocompromised. The goal of this article is to educate parents on the risks and symptoms of common pet-borne illnesses that are difficult to prevent from coming into the home.

Introduction: Permanent vascular access (arteriovenous fistula (AVF), arteriovenous graft (AVG)) is susceptible to acute events that reduce patency. The temporary central venous catheter (CVC) constitutes bridging therapy for primary vascular access dysfunction. The impact of “residence time” on the rate of dysfunction/thrombosis or infection remains to be explored.AIM: 1) To evaluate the impact of CVC residence time on outcomes (infection or Thrombosis/dysfunction) in consecutive temporary CVCs adjusted for the insertion site (upper site vs. lower site).2) To establish a cut-off resident time.Patients and methods: Seventeen prevalent hemodialysis patients with three consecutive CVCs are followed up prospectively in an observational study for a period equivalent to the permanence of the CVCs. The data is recorded at the beginning of the CVC time. The diagnosis of catheter-related bloodstream infection and thrombosis/dysfunction is made following the K-Doqi 2019 guidelines.Statistical analysis: Seventeen hemodialysis patients (51 CVCs) were included. The ‘CVC resident time’ of each individual patient ((i.e. βcoefficient (log-transformed)*AUC)) was determined using LMM and then inserted into multivariate Cox models to assess infection and dysfunction/thrombosis outcomes (Joint Models). The AUC was calculated at various baseline levels of CVC time (10th……50th percentile). The cut-off point for thrombosis in CVC time corresponds to the mean of the CVC time at the 30th percentile of all CVCs.Results: The CVC time is different for CVC’s site insertion and sequence. From the analysis of multivariate joint models, CVC resident time appears not to be significant for infection, but heterogenicity for the insertion site (ref3-4=upper site) is significant for the outcome of thrombosis/dysfunction. From the study of survival analysis, the free survival from outcomes by CVC site insertion appears to be significant for thrombosis/dysfunction. The average time of CVCs’ calculation at the 30th percentile is 14 days (cut-off).Conclusion: No tunneled hemodialysis Catheter (NTHC) residence time is considered not to be a risk factor for infection, but it represents a risk factor for lower access thrombosis. After the cut-off time of 14 days, the advantage of the higher NTHCs is lost.

Background: Long-term care for patients with chronic kidney disease, whether in the pre or post-dialysis period, has a destructive impact on patients and their caregivers that can significantly worsen their quality of life. Objectives: To assess the quality of life (QOL) among caregivers of children suffering from chronic kidney disease and to identify the possible factors affecting their quality of life. Subjects and methods: Between March 2023 and May 2023, a cross-sectional questionnaire-based study was conducted at King Saud Medical City for caregivers of all pediatric patients aged from 6 months to 14 years with CKD stage-3B and beyond who have been followed up for at least three months in the pre or post-dialysis period since 2015. The study applied the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) to evaluate the caregivers’ quality of life. Result: A total of 95 caregivers were involved in the study. The age ranged between 24 and 53 years, with an arithmetic mean of 39.3 and a standard deviation of (± 6.6) years, and almost two-thirds (65.3%) were Saudi nationals. Most pediatric patients were on peritoneal renal dialysis (41%), whereas 29.5% were on hemodialysis. The mean and SD of the overall score was 56.10 ± 17.40 out of a possible range of 0-100. Regarding its domains, the highest score was observed regarding the social domain (62.11 ± 21.12), whereas the lowest was the physical domain (49.55 ± 18.42). After controlling for confounding, married, high socio-economic, and more educated caregivers have higher QOL scores than singles, low socio-economic, and lower knowledgeable caregivers, and the three factors together were responsible for approximately 41% variability of the QOL score (r – square = 0.406). Bivariate Pearson correlation showed significant correlations among different quality-of-life domains (p < 0.001). Conclusion: There was a significant association between quality-of-life scores and demographic characteristics of chronic kidney disease caregivers; they need the highest support to cope with their delicate patients. 

Objective: To investigate the value of machine learning and traditional Cox regression models in predicting postoperative survivorship in patients with adenocarcinoma of the esophagogastric junction (AEG).Methods: This study analyzed clinicopathological data from 203 patients. The Cox proportional risk model and four machine learning models were constructed and internally validated. ROC curves, calibration curves, and clinical decision curves (DCA) were generated. Model performance was assessed using the area under the curve (AUC), while calibration curves determined the fit and clinical significance of the model.Results: The AUC values of the 3-year survival in the validation set for the Cox regression model, extreme gradient boosting, random forest, support vector machine, and multilayer perceptron were 0.870, 0.901, 0.791, 0.832, and 0.725, respectively. The AUC values of 5-year survival in the validation set for each model were 0.915, 0.916, 0.758, 0.905, and 0.737, respectively. The internal validation AUC values for the four machine learning models, extreme gradient boosting, random forest, support vector machine, and multilayer perceptron, were 0.818, 0.772, 0.804, and 0.745, respectively.Conclusion: Compared with Cox regression models, machine learning models do not need to satisfy the assumption of equal proportionality or linear regression models, can include more influencing variables, and have good prediction performance for 3-year and 5-year survival rates of AEG patients, among which, XGBoost models are the most stable and have significantly better prediction performance than other machine learning methods and are practical and reliable.

The article presents materials that make it possible to understand the reason for the absence of one of the classic signs of inflammatory processes in patients with acute pneumonia. The peculiarities of the functional significance of the lungs for the body are the reason that in the case of inflammation in the tissues of the organ, nature has provided for the presence of a more important adaptive mechanism instead of pain as a signal sign. Understanding the causes of the absence of pain in pneumonia in the initial period, which is most responsible for timely and effective care for these patients, allows us to look at the pathogenesis of the disease from a new point of view, which is of fundamental importance for the correction and selection of pathogenetic means of care.

In this report, we describe a case of a small bowel obstruction in the immediate postoperative period following an abdominal myomectomy. After failing conservative management, the patient underwent diagnostic laparoscopy, and the exposed tail of an absorbable barbed V-loc™ (Covidien™, Mansfield, MA, USA) suture used during the myomectomy was identified as the nidus of the small bowel obstruction. While barbed-suture-related bowel obstruction is a known rare complication that is well described in the general surgery literature, it is less documented in gynecological surgery literature. We anticipate the risk to be higher after multiple myomectomy, as postoperative contracture of the uterus can cause protrusion and exposure of the barbed suture tail. Though barbed suture can be safely used for hysterotomy closure during myomectomy, surgeons who opt to use barbed suture during myomectomy should be aware of this potential complication, take intra-operative measures to reduce the risk of postoperative tail protrusion and maintain a high index of suspicion for bowel obstruction in the immediate postoperative period.

The combustion properties of energetic materials have been extensively studied in the scientific literature. With the rapid advancement of data science and artificial intelligence techniques, predicting the performance of solid rocket propellants (SRPs) has become a key focus for researchers globally. Understanding and forecasting the characteristics of SRPs are crucial for analyzing and modeling combustion mechanisms, leading to the development of cutting-edge energetic materials. This study presents a methodology utilizing artificial neural networks (ANN) to create multifactor computational models (MCM) for predicting the burning rate of solid propellants. These models, based on existing burning rate data, can solve direct and inverse tasks, as well as conduct virtual experiments. The objective functions of the models focus on burning rate (direct tasks) and pressure (inverse tasks). This research lays the foundation for developing generalized combustion models to forecast the effects of various catalysts on a range of SRPs. Furthermore, this work represents a new direction in combustion science, contributing to the creation of a High-Energetic Materials Genome that accelerates the development of advanced propellants.

Introduction: The current gold standard for SARS-CoV-2 diagnosis by real-time RT-PCR has limitations of gene numbers that can be detected. In this study, we developed a low-cost and high-throughput next-generation sequencing technology that can overcome the limitations of RT-PCR. Methodology: A targeted sequencing panel (TSP) consisting of approximately 500 amplicons was designed that can simultaneously detect a broad range of gene loci of SARS-CoV-2 and genes for the most common viruses of respiratory infectious viruses in a single run of up to 96 samples. 448 samples and 31 control samples were examined independently with both TSP and RT-PCR, results were compared for accuracy and other indicators. Results:  TSP identified 50 SARS-CoV-2 positive samples with a 99.33% match to RT-PCR results. It is not surprising that TSP also identified multiple viral infections from 96 samples, whereas RT-PCR could not. TSP demonstrated its ability to conclude diagnosis for those undecided from RT-PCR tests. Conclusion: Our data demonstrated that TSP is a fast and accurate test for detecting multiple pathogen infections of the respiratory tract.

Background: Systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH) is characterized by pulmonary arterial remodeling resulting in right ventricular failure and death if untreated. Despite therapeutic advances, there is survival variability within the SSc-PAH population. The aim of this study was to delineate high-risk subgroups of SSc-PAH using readily available clinical parameters.Methods: We analyzed data from the PHAROS database, a prospective observational registry of incident SSc-PAH patients. Latent class modeling was performed based on trends in 6MWD over time. We compared survival between the clusters regarding baseline clinical parameters and changes in these parameters over time.Results: We identified four unique groups within 103 patients meeting our inclusion criteria, based on trajectories of 6MWD. Patients in Cluster 4 exhibited a decline in 6MWD over time and had the worst prognosis with a median survival of 3 years. Patients in Cluster 3, with the lowest baseline 6MWD, were associated with lower median survival (5 years) when compared to Clusters 1 and 2 (> 9 and 7 years, respectively), despite an improvement in 6MWD over time. There were no meaningful changes in SF-36 and WHO functional class between the clusters, but BNP trended higher over time in the higher-risk clusters. Conclusion: We identified high-risk subsets of SSc-PAH characterized by significantly worse survival. Incident SSc-PAH patients with a decline in 6MWD over time or low baseline 6MWD had worse survival when compared to SSc-PAH patients who demonstrated relatively stable or mild reduction in 6MWD over time.

German universities of applied sciences have provided a large number of technical talents to society, and have made significant contributions to the enhancement of German education and industry. Drawing on the professional construction experience of German universities of applied sciences, this paper summarizes the path of civil engineering materials courses in China's high-level applied universities. The proposals for curriculum reform were discussed. Colleges and universities can cultivate professionals with strong hands-on abilities, strong exploration abilities, and a scientific research spirit. In addition, this paper puts forward that China needs to make changes from three levels: the country, universities, and teachers. Based on learning from the experience of collaborative education between teaching and scientific research in German universities, we have embarked on a road of education with China characteristics.

Background: Patients with acute and chronic leukemia presenting with hyperleukocytosis are at risk of developing leukostasis which has serious and life-threatening complications. Leukapheresis is usually performed to reduce the complications of leukostasis in patients presenting with hyperleukocytosis and clinical manifestations compatible with leukostasis. Methods and materials: A retrospective study of patients with acute and chronic leukemia who received leukapheresis for hyperleukocytosis between the 1st of January 2013 and the 31st of December 2023 at King Fahad Specialist Hospital (KFSH) in Dammam, Saudi Arabia was performed. Results: Over a period of 11 years, a total of 50 patients with acute and chronic leukemia presenting with hyperleukocytosis and clinical manifestations of leukostasis; 32 patients with acute leukemia (AL) and 18 patients with chronic myeloid leukemia (CML); received leukapheresis at our institution. Among the 32 patients with AL who received leukapheresis, 24 patients (75%) had acute myeloid leukemia (AML), 7 patients (21.88%) had acute lymphoblastic leukemia (ALL) and 1 patient (3.13%) had bilineage acute leukemia (BAL). At presentation of their AL: 3 patients (9.38%) had fever, 9 patients (28.13%) had infections, 4 patients (12.5%) had palpable spleen or liver, 6 patients (18.75%) had palpable external lymph nodes, and 9 patients (28.13%) had extramedullary disease (EMD). After receiving induction and consolidation cycles of chemotherapy, 11 patients (34.38%) of AL patients received allogeneic hematopoietic stem cell transplantation (HSCT). At the end of the follow-up, 17 patients (53.1%) with AL were alive while 15 patients (46.9%) were dead. The 8-year overall survival (OS) for all patients with AL subjected to leukapheresis was 47%. The 5 years OS for patients with AL who subsequently received HSCT and those who did not receive allogeneic HSCT were 70% and 40% respectively. The mean white blood cell (WBC) count of CML patients subjected to leukapheresis was 465.5 × 109/L, 11 patients (61.11%) had clear signs of leukostasis, and 8 patients (44.44%) had splenomegaly at presentation. Regarding the disease stage at presentation, 14 CML patients (77.78%) had chronic phase (CP), 2 patients (11.11%) had accelerated phase (AP) and 2 patients (11.11%) had blast phase (BP). Regarding the fate of CML patients at the end of the study were: 15 (83.33%) were alive, 1 (5.56%) dead, and 2 (11.11%) were unknown as they lost follow-up. However, the 10-year OS of patients with CML subjected to leukapheresis was 90%. Conclusion: Patients with acute or chronic leukemia presenting with hyperleukocytosis and either ongoing or impending leukostasis should have urgent cytoreductive chemotherapy and leukapheresis to prevent life-threatening complications. Although the outcome of AL patients presenting with leukostasis is generally poor, prompt cytoreductive therapy and leukapheresis, followed by induction chemotherapy and allogeneic HSCT may improve the outcome. Also, urgent cytoreduction including leukapheresis improves the outcome of patients with CML presenting with hyperleukocytosis and leukostasis.

The Canadian healthcare system, grappling with issues like systemic and intelligently established structural anti-black racism, including indigenous nations; even within Pathology and Laboratory Medicine Communities: and deteriorating outcomes, sees potential in AI to address challenges, though concerns exist regarding exacerbating discriminatory practices. In clinical pathology, AI demonstrates superior diagnostic accuracy compared to pathologists in a study, emphasizing its potential to improve healthcare. However, AI governance is crucial to navigating ethical, legal, and societal concerns. The Royal College of Physicians of Canada acknowledges the transformative impact of AI in healthcare but stresses the need for responsible AI tools co-developed by diverse teams. Despite positive attitudes towards AI in healthcare, concerns about patient safety, privacy, and autonomy highlight the necessity for comprehensive education, engagement, and collaboration. Legal concerns, including liability and regulation, pose challenges, emphasizing the need for a robust regulatory framework. AI application in healthcare is categorized as high-risk, demanding stringent regulation to ensure safety, efficacy, and fairness. A parallel is drawn to drug regulation processes, suggesting a similar approach for AI. The lack of transparency in AI-based decision-making raises ethical questions, necessitating measures to address biases and ensure patient privacy. Social accountability is crucial to prevent AI from exacerbating health disparities and harming marginalized communities. In conclusion, while AI offers potential benefits in clinical pathology, a cautious approach with comprehensive governance measures is essential to mitigate risks and ensure ethical AI integration into healthcare.

Li B, Chen BW, Xia LS. The Initial Experience of Laparoscopic Management for Type VI Choledochal Cyst in Children. J Laparoendosc Adv Surg Tech A. 2024 Mar;34(3):280-283. doi: 10.1089/lap.2023.0229. Epub 2023 Oct 16. PMID: 37844069. Dumitrascu T, Lupescu I, Ionescu M. The Todani classification for bile duct cysts: an overview. Acta Chir Belg. 2012 Sep-Oct;112(5):340-5. doi: 10.1080/00015458.2012.11680849. PMID: 23175921. Dutta S, Jain A, Reddy A, Nelamangala Ramakrishnaiah VP. Anomalous Pancreaticobiliary Duct Junction in an Unusual Case of Synchronous Gallbladder and Bile Duct Malignancy. Cureus. 2021 Feb 13;13(2):e13331. doi: 10.7759/cureus.13331. PMID: 33738174; PMCID: PMC7959653. Xia HT. Standardized Surgical Management for Cystic Dilation of the Bile Ducts Based on Clinical and Pathological Studies: A Narrative Review. Gastroenterol Res Pract. 2020 Sep 15;2020:3432786. doi: 10.1155/2020/3432786. PMID: 33014038; PMCID: PMC7512076.

Inflammation is a natural response of the body to defend itself against potential threats and can be reduced through physical activity, proper nutrition, and the use of herbal medicines, which are medicinal plants. In the study, we aim to examine the anti-inflammatory effects of the volatile and ethanolic fractions of two commonly used medicinal plants, Equisetum arvense, and Baccharis trimera. The essential oils were obtained by hydrodistillation of the fresh leaves of the plants, while the ethanolic extracts were obtained using classical methodologies. All fractions were tested for anti-inflammatory activity, evaluating their ability to stabilize the red blood cell membrane and inhibit the spreading, and phagocytosis by macrophages, at concentrations varying from 200 to 600 µg mL-1. The results of the experiments suggest that the ethanolic fraction of B. trimera shows promising results compared to the positive controls. Our investigations thus contribute to the specialized literature on the use of herbal medicines around nutrition, providing guidance for future studies on these fractions.

The aging global population requires a new social model to meet the growing social, economic, and physical needs of seniors. Western social models need to be reconsidered in light of examples that support communal ways of living, which are sustainable through smart city design for more supportive geriatric care systems. To address the complex problems of geriatric care in this growing aging population with specific needs related to increased lifespan and limited financial resources, the use of emerging technologies, such as artificial intelligence (AI) and the Internet of Things (IoT), should be considered. As retirement ages rise and funds for retirement continue to decrease automated and sustainable solutions need to be sought. The ethical need to consider citizens not as customers but as decision-makers and to validate the ethical nature of medical decisions made for and by individuals should also be prioritized. This study provides recommendations for a smart city design and highlights the need for reflection on the ethics, modernization, and management of geriatric care. It suggests that technological devices can benefit health system reform by facilitating problem-solving. Overall, this new model integrates communal living and non-Western values with emerging technologies to address the growing need for geriatric care and the well-being of seniors.

Introduction: In the latest WHO classification of central nervous system tumors, Mitotic Index (MI) counted on Phosphohistone-H3 stained slides (pHH3-MI) has been suggested as a valid proliferative marker in various tumors including in the evaluation of meningioma grading.We aim to report our own experience in assessing the efficiency of the anti-pHH3 antibody as a grading tool for meningiomas.Methods: A retrospective study was conducted on a series of 40 meningiomas diagnosed from March 2020 to April 2021 at the Pathology Department of the Military Hospital of Tunis. We attempted immunohistochemistry and compared MI assessed on both pHH3 and HE-stained slides.Results: According to the HE-MI and pHH3-MI, the 40 cases of meningiomas were respectively divided into 35 versus 29 grade 1 cases, four versus eight grade 2 cases, and one versus three grade 3 cases. A highly significant correlation was found between pHH3-MI and HE-MI (p < 0.001). A significantly higher sensitivity in the pHH3 counting method was reported in our study. Discussion: we found, in accordance with the literature, that pHH3-MI is more reliable and accurate in mitotic counting, therefore exhibiting a high sensitivity in tumor grading, reported by an upgrade within 22,5% of the cases.Conclusion: PHH3-MI count facilitated a rapid reliable grading of meningiomas. However, molecular characteristics that could have a potentially significant impact on tumor progression should be the subject of further research.