Regional variations in HIV diagnosis in Japan before and during the COVID-19 pandemic.

Background: The number of people undergoing voluntary HIV testing has abruptly decreased since 2020. The geographical heterogeneity of HIV infection and the impact of COVID-19 on the diagnosis of HIV at regional level are important to understand. This study aimed to estimate the HIV incidence by geographical region and understand how the COVID-19 pandemic influenced diagnosis of HIV. Methods: We used an extended back-calculation method to reconstruct the epidemiological dynamics of HIV/AIDS by geographical region. We used eight regions: Tokyo, the capital of Japan, Hokkaido plus Tohoku, Kanto plus Koshinetsu (excluding Tokyo), Hokuriku, Tokai, Kinki, Chugoku plus Shikoku, and Kyushu plus Okinawa. Four different epidemiological measurements were evaluated: (i) estimated HIV incidence, (ii) estimated rate of diagnosis, (iii) number of undiagnosed HIV infections, and (iv) proportion of HIV infections that had been diagnosed. Results: The incidence of HIV/AIDS during the COVID-19 pandemic from 2020 to 2022 increased in all regions except Kanto/Koshinetsu (51.3 cases/year), Tokyo (183.9 cases/year), Hokuriku (1.0 cases/year), and Tokai (43.1 cases/year). The proportion of HIV infections that had been diagnosed only exceeded 90% in Tokyo (91.7%, 95% confidence interval (CI): 90.6, 93.3), Kanto/Koshinetsu (91.0%, 95% CI: 87.3, 97.8), and Kinki (92.5%, 95% CI: 90.4, 95.9). The proportion of infections that had been diagnosed was estimated at 83.3% (95% CI: 75.1, 98.7) in Chugoku/Shikoku and 80.5% (95% CI: 73.9, 91.0) in Kyusyu/Okinawa. Conclusions: In urban regions with major metropolitan cities, including Tokyo, Kinki, and Kanto/Koshinetsu, the number of undiagnosed HIV infections is substantial. However, the proportion of undiagnosed infections was estimated to be smaller than in other regions. The diagnosed proportion was the lowest in Kyusyu/Okinawa (80.5%), followed by Chugoku/Shikoku and Hokkaido/Tohoku. The level of diagnosis in those regional prefectures may have been more influenced and damaged by the COVID-19 pandemic than in urban settings.

Sternalis Muscle: A Cadaveric Case Report of a Rare Variant With Multiple Branching.

The sternalis muscle is a rare anatomical variant located in the anterior thoracic wall. Understanding variations in the sternalis muscle anatomy is essential for clinicians, especially radiologists and surgeons to prevent misdiagnosis and avoid complications during surgical procedures in the anterior thoracic region. We present a unique case of bilateral branched sternalis muscles. On either side, the sternalis muscle lies deep to the breast and superficial fascia and superficial to pectoralis major muscle and pectoral fascia. Each sternalis muscle is branched into medial and lateral slips with the medial slip larger than the lateral slip. The medial slip of the right sternalis was larger than the medial slip of the left sternalis. The lateral slip of the left sternalis was larger than the lateral slip of the right sternalis. The lateral slip of the left sternalis muscle has a curved course with superior-lateral convexity and inferomedial concavity. Near its middle, the left sternalis lateral slip is branched into two smaller slips separated by a narrow cleft. The left sternalis muscle in our report is a new variant with multiple branching, which cannot be matched to any type of the previously described classifications. In this case report, we discussed the need of modification of the currently available sternalis classification system to accommodate all types of the previously reported sternalis muscles including the branching pattern of this muscle.

Biallelic Deletion of PEX26 Exon 4 in a Boy with Phenotypic Features of both Zellweger Syndrome and Infantile Refsum Disease.

Introduction: Peroxisome biogenesis disorders (PBDs) encompass a group of diseases marked by clinical and genetic heterogeneity. Phenotypes linked to PBDs include Zellweger syndrome, neonatal adrenoleukodystrophy, infantile Refsum disease (IRD), rhizomelic chondrodysplasia punctata type 1, and Heimler syndrome. PBD phenotypes manifest through hypotonia, developmental delay, facial dysmorphism, seizures, liver dysfunction, sensorineural hearing loss, and retinal dystrophy. Methods: The proband underwent comprehensive clinical evaluation, followed by whole-exome sequencing (WES) coupled with copy number analysis (CNV), aimed at identifying potential disease-causing variants aligning with the observed phenotype. Results: Our findings detail an individual exhibiting developmental delay, hearing loss, visual impairment, hepatomegaly, and splenomegaly, attributed to a biallelic deletion of exon 4 in the PEX26 gene. The WES analysis of the index case did not uncover any pathogenic/likely pathogenic single-nucleotide variations that could account for the observed clinical findings. However, the CNV data derived from WES revealed a homozygous deletion in exon 4 of the PEX26 gene (NM_001127649.3), providing a plausible explanation for the patient's clinical features. The exon 4 region of PEX26 encodes the transmembrane domain of the protein. The transmembrane domain plays a crucial role in anchoring the protein within lipid bilayers, and its absence can disrupt proper localization and functioning. As a result, this structural alteration may impact the protein's ability to facilitate essential cellular processes related to peroxisome biogenesis and function. Conclusion: The index patient, which presented with hearing loss, retinal involvement and hepatic dysfunction in adolescence age, has atypical clinical course that can be considered unusual for Zellweger syndrome (ZS) and IRD phenotypes, and its rare genotypic data (in-frame single exon deletion) expands the PBD disease spectrum. This study revealed for the first time that PEX26 protein transmembrane domain loss exhibits an unusual course with clinical findings of IRD and ZS phenotypes. WES studies, incorporating CNV analyses, empower the identification of novel genetic alterations in genes seldom associated with gross deletion/duplication variations, such as those in the PEX26 gene. This not only enhances diagnostic rates in rare diseases but also contributes to broadening the spectrum of causal mutations.

European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit.

The European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented. EoL legislation and the importance of respecting the autonomy and preferences of patients were given close attention. Differences in EoL care depending on country income and healthcare provision were considered. Structured EoL decision-making strategies are recommended to improve outcomes of patients and relatives, as well as staff satisfaction and mental health. Early integration of palliative care and the use of standardized tools for symptom assessment are suggested for patients at high risk of dying. Communication training for ICU staff and printed communication aids for families are advocated to improve outcomes and satisfaction. Methods for enhancing family-centeredness of care include structured family conferences and culturally sensitive interventions. Conflict-management protocols and strategies to prevent burnout among healthcare professionals are also considered. The work done to develop these guidelines highlights many areas requiring further research.

Diagnostic yield of exome sequencing-based copy number variation analysis in Mendelian disorders: a clinical application.

Next-generation sequencing (NGS) coupled with bioinformatic tools has revolutionized the detection of copy number variations (CNVs), which are implicated in the emergence of Mendelian disorders. In this study, we evaluated the diagnostic yield of exome sequencing-based CNV analysis in 449 patients with suspected Mendelian disorders. We aimed to assess the diagnostic yield of this recently utilized method and expand the clinical spectrum of intragenic CNVs. The cohort underwent whole exome sequencing (WES) and clinical exome sequencing (CES). Using GATK-gCNV, we identified 12 pathogenic CNVs that correlated with their clinical findings and resulting in a diagnostic yield of 2.67%. Importantly, the study emphasizes the role of CNVs in the etiology of Mendelian disorders and highlights the value of exome sequencing-based CNV analysis in routine diagnostic processes.

Multiple Variations in Abdominal Aorta Branching and Their Clinical Significance: A Case Report.

The abdominal aorta extends from the T12 vertebra and terminates at the L4 vertebra. It gives off anterior, lateral, and posterior branches that supply the abdominal viscera and vertebrae at this level, eventually dividing into the common iliac arteries. Dissection of the abdominal aorta and its branches from a female cadaver revealed several variations: the right inferior phrenic artery arose from the celiac trunk, the left middle suprarenal artery originated at the L1 vertebra, while the right middle suprarenal artery arose at the L2 vertebra, and the left and right renal arteries emerged from the L2 and L1 vertebrae, respectively. The gonadal arteries did not originate from the abdominal aorta. Inferior phrenic arteries may arise from the abdominal aorta, celiac trunk, or occasionally form renal arteries and are linked with extrahepatic supply in hepatocellular carcinoma. Middle suprarenal arteries typically originate from the abdominal aorta at L1, but may occasionally arise from L2 or be absent. Variations in the middle suprarenal arteries often correspond with variations in the inferior phrenic and gonadal arteries. Renal arteries may arise at the L1 vertebra, the L1/L2 intervertebral disc, or the L2 vertebra, with additional variations reported. The gonadal arteries may not originate from the abdominal aorta in some cases. These branching variations of the abdominal aorta are important for clinical, diagnostic, and therapeutic procedures and should be documented accordingly.

Assessment and prediction of Water Quality Index (WQI) by seasonal key water parameters in a coastal city: application of machine learning models.

The Water Quality Index (WQI) provides comprehensive assessments in river systems; however, its calculation involves numerous water quality parameters, costly in sample collection and laboratory analysis. The study aimed to determine key water parameters and the most reliable models, considering seasonal variations in the water environment, to maximize the precision of WQI prediction by a minimal set of water parameters. Ten statistical or machine learning models were developed to predict the WQI over four seasons using water quality dataset collected in a coastal city adjacent to the Yellow Sea in China, based on which the key water parameters were identified and the variations were assessed by the Seasonal-Trend decomposition procedure based on Loess (STL). Results indicated that model performance generally improved with adding more input variables except Self-Organizing Map (SOM). Tree-based ensemble methods like Extreme Gradient Boosting (XGB) and Random Forest (RF) demonstrated the highest accuracy, particularly in winter. Nutrients (Ammonia Nitrogen (AN) and Total Phosphorus (TP)), Dissolved Oxygen (DO), and turbidity were determined as key water parameters, based on which, the prediction accuracy for Medium and Low grades was perfect while it was over 80% for the Good grade in spring and winter and dropped to around 70% in summer and autumn. Nutrient concentrations were higher at inland stations; however, it worsened at coastal stations, especially in summer. The study underscores the importance of reliable WQI prediction models in water quality assessment, especially when data is limited, which are crucial for managing water resources effectively.

Numerical study on the cerebral blood flow regulation in the circle of Willis with the vascular absence and internal carotid artery stenosis.

Objectives: This study explores how vascular stenosis and absence affect the regulation of cerebral blood flow in the Circle of Willis (CoW) and the hemodynamic changes downstream of the stenosis. Materials and Methods: Forty idealized CoW models were simulated to analyze the impact of vascular absence and internal carotid artery (ICA) stenosis on hemodynamics. Inlet conditions were set using a physiological pressure waveform, and outflow boundaries were modeled using three-element Windkessel models. Results: The absence of vessels such as RP1, LP1, RA1, or LA1 had a comparable effect on total blood flow to a 40% stenosis of the left internal carotid artery (LICA) across the entire CoW. Specifically, when LP1 and RA1 were absent with a 50% LICA stenosis, the total blood flow closely resembled that of a complete CoW with 75% LICA stenosis. In cases of proximal ICA stenosis, downstream regions showed elevated oscillatory shear index (OSI >0.2) and reduced time-averaged wall shear stress (TAWSS <1 Pa). With increasing stenosis severity, areas of high OSI shifted, and regions of low TAWSS expanded notably. At 75% stenosis, the area with TAWSS <1 Pa downstream significantly increased. Until complete occlusion, the area of low TAWSS and high OSI were maximized. Conclusion: This study underscores how anatomical variations in the CoW, combined with ICA stenosis, impact both total cerebral blood flow and its distribution among different outlets. Moreover, it highlights the potential for increased atherosclerosis development in affected areas. Particularly notable is the finding the absence of LP1 and RA1 vessels alongside 50% LICA stenosis results in blood flow patterns similar to those seen with 75% LICA stenosis in a complete CoW, emphasizing clinical implications for the patient. Hemodynamic changes, including TAWSS and OSI, are most pronounced downstream of the stenosis especially when the stenosis rate exceeds 75%.

Obtention of viable cell suspensions from breast cancer tumor biopsies for 3D chromatin conformation and single-cell transcriptome analysis.

Molecular and cellular characterization of tumors is essential due to the complex and heterogeneous nature of cancer. In recent decades, many bioinformatic tools and experimental techniques have been developed to achieve personalized characterization of tumors. However, sample handling continues to be a major challenge as limitations such as prior treatments before sample acquisition, the amount of tissue obtained, transportation, or the inability to process fresh samples pose a hurdle for experimental strategies that require viable cell suspensions. Here, we present an optimized protocol that allows the recovery of highly viable cell suspensions from breast cancer primary tumor biopsies. Using these cell suspensions we have successfully characterized genome architecture through Hi-C. Also, we have evaluated single-cell gene expression and the tumor cellular microenvironment through single-cell RNAseq. Both technologies are key in the detailed and personalized molecular characterization of tumor samples. The protocol described here is a cost-effective alternative to obtain viable cell suspensions from biopsies simply and efficiently.

Spatiotemporal evolution of dry and wet and quantitative analysis of the influence of meteorological factors based on MI and the FAO P-M model.

The frequent occurrence of extreme climate events disrupts the regional water budget balance and leads to changes in the dry and wet conditions of the surface, making the water surplus and deficit more complex and variable. To explore the quantitative relationship between the spatiotemporal evolution of dry and wet conditions and meteorological factors in the Hexi Corridor under changing environmental conditions, the relative moisture index (MI) and FAO Penman-Monteith (FAO P-M) model were combined to construct a partial differential quantitative attribution model for dry and wet variations affected by climate factors in the Hexi Corridor. The results show that: (1) MI in the Hexi Corridor increased significantly (Z = 2.341) during 1960-2019, showing a wet-trend change, and the degree of drought increased from southeast to northwest in the Hexi Corridor. (2) The order of drought degree in four seasons is as follows: winter (- 0.95), spring (- 0.93), autumn (- 0.89) and summer (- 0.83). (3) The frequency of extreme drought, severe drought, moderate drought, and mild drought within 60 years of 21 meteorological stations accounted for 28.38%, 50.48%, 8.85%, and 7.38%, respectively, and the frequency above severe drought was the highest. (4) The sensitivity of meteorological factors gradually increased from northwest to southeast, and MI was the most sensitive to the change of precipitation (P), followed by net radiation (Rn), wind speed (u2), mean temperature (Tmean), relative humidity (RH) and maximum temperature (Tmax). MI was the least sensitive to the change of minimum temperature (Tmin). P is the most important meteorological variable that contributes to the increase of MI, followed by u2, Tmean, and Tmin. Rn, Tmax, and RH have the least influence, and the total contribution of the seven meteorological factors is 85.59%. Compared with the reference evapotranspiration, P is the main factor affecting the dry and wet variations in Hexi Corridor.

Seasonal Comparison of Pre-Adolescent Soccer Players' Physical Performance Using an Objective Physical Test Battery.

BACKGROUND/OBJECTIVE: Soccer is a multifactorial sport, requiring physical, psychological, technical, and tactical skills to succeed. Monitoring and comparing physical characteristics over time is essential to assess players' development, customize training, and prevent injury. The use of wearable sensors is essential to provide accurate and objective physical data. METHODS: In this longitudinal study, 128 male adolescent soccer players (from Under 12 to Under 19) were evaluated at two time points (pre- and post-season). Participants completed the Euleria Lab test battery, including stability, countermovement and consecutive jumps, agility, and quick feet tests. A single Inertial Measurement Unit sensor provided quantitative data on fifteen performance metrics. Percentage changes were compared to the Smallest Worthwhile Changes to assess significant changes over time. RESULTS: The results showed significant improvements in most variables, including a 19.7% increase in quick feet, 10.9% in stability, and 9.6% in countermovement jumps. In principal component analysis, we identified four principal components-strength-power, balance, speed-agility, and stiffness-that explained over 80% of the variance. CONCLUSIONS: These findings align with previous studies assessing seasonal changes in adolescent soccer players, showing that the proposed test battery seems to be adequate to highlight physical performance changes and provide coaches with meaningful data to customize training and reduce injury rates.

Single nucleotide polymorphisms in the development of osteomyelitis and prosthetic joint infection: a narrative review.

Currently, despite advancements in diagnostic and therapeutic modalities, osteomyelitis and prosthetic joint infection (PJI) continue to pose significant challenges for orthopaedic surgeons. These challenges are primarily attributed to the high degree of heterogeneity exhibited by these disorders, which are influenced by a combination of environmental and host factors. Recent research efforts have delved into the pathogenesis of osteomyelitis and PJI by investigating single nucleotide polymorphisms (SNPs). This review comprehensively summarizes the current evidence regarding the associations between SNPs and the predisposition to osteomyelitis and PJI across diverse populations. The findings suggest potential linkages between SNPs in genes such as IL-1, IL-6, IFN-γ, TNF-α, VDR, tPA, CTSG, COX-2, MMP1, SLC11A1, Bax, NOS2, and NLRP3 with the development of osteomyelitis. Furthermore, SNPs in genes like IL-1, IL-6, TNF-α, MBL, OPG, RANK, and GCSFR are implicated in susceptibility to PJI. However, it is noted that most of these studies are single-center reports, lacking in-depth mechanistic research. To gain a more profound understanding of the roles played by various SNPs in the development of osteomyelitis and PJI, future multi-center studies and fundamental investigations are deemed necessary.

Genome variations in sea cucumbers: Insights from genome survey sequencing and comparative analysis of mitochondrial genomes.

Sea cucumbers, marine benthic invertebrates, play crucial roles in maintaining the stability of marine ecosystems and hold key evolutionary positions. However, information regarding their genomes remains limited. Here, we conducted genome survey analyses on seven species from four orders. Results indicated that Colochirus anceps, Colochirus quadrangularis, and Pseudocolochirus violaceus within the order Dendrochirotida have significantly larger genomes (2238-3754 Mbp) compared to conventional sea cucumber genomes, accompanied by a very high proportion of repeat sequences (69.39-72.52 %). While Holothuria edulis and Holothuria atra exhibited similar genome sizes comparable to those of other species within the order Holothuriida, heterozygosity and repeat content varied among all the six species in this order. The representative species Apostichopus californicus of the order Synallactida possesses the smallest genome size (573.45Mbp) within its order, but its heterozygosity (2.24 %) is significantly higher than that of other species. The representative species Synapta maculata of the order Apodida exhibited a normal genome size (900.97 Mbp), lower proportion of repeat sequences (42.19 %), and lower heterozygosity (0.84 %), making it the species with the least challenges for genome sequencing and assembly in the future among all surveyed species. Subsequently, we compiled genomic information from a total of 19 sea cucumber genomes, both newly sequenced and previously reported, revealing a significant linear relationship (P = 0.0001) between genome size and the proportion of repeat sequences in sea cucumbers. Additionally, phylogenetic and comparative analysis of mitochondrial genomes among them indicated extensive rearrangements within the order Apodida, leading to significant discrepancies between mitochondrial and nuclear genome phylogenies.

VUS next in rare diseases? Deciphering genetic determinants of biomolecular condensation.

The diagnostic odysseys for rare disease patients are getting shorter as next-generation sequencing becomes more widespread. However, the complex genetic diversity and factors influencing expressivity continue to challenge accurate diagnosis, leaving more than 50% of genetic variants categorized as variants of uncertain significance.Genomic expression intricately hinges on localized interactions among its products. Conventional variant prioritization, biased towards known disease genes and the structure-function paradigm, overlooks the potential impact of variants shaping the composition, location, size, and properties of biomolecular condensates, genuine membraneless organelles swiftly sensing and responding to environmental changes, and modulating expressivity.To address this complexity, we propose to focus on the nexus of genetic variants within biomolecular condensates determinants. Scrutinizing variant effects in these membraneless organelles could refine prioritization, enhance diagnostics, and unveil the molecular underpinnings of rare diseases. Integrating comprehensive genome sequencing, transcriptomics, and computational models can unravel variant pathogenicity and disease mechanisms, enabling precision medicine. This paper presents the rationale driving our proposal and describes a protocol to implement this approach. By fusing state-of-the-art knowledge and methodologies into the clinical practice, we aim to redefine rare diseases diagnosis, leveraging the power of scientific advancement for more informed medical decisions.

Unilateral secondary middle turbinate and ipsilateral bifid inferior turbinate with presence of uncinate process: Is it true bifid inferior turbinate?

Anatomical variations of the nasal turbinate, such as secondary middle turbinate (SMT) and bifid inferior turbinate (BIT), are sporadic. In most cases, SMT and BIT are generally bilateral. Moreover, the uncinate process is unusual in BIT because it is widely acknowledged that BIT could be an abnormality of the uncinate process. However, we found an unusual case of a 19-year-old female with 2 compartments on the right nostril since birth. CT scan and nasal endoscopy revealed unilateral SMT and ipsilateral BIT with the presence of an uncinate process. Therefore, considering the different origins of the uncinate process and inferior turbinate, BIT with the uncinate process can be referred to as true BIT, while BIT without the uncinate process can be referred to as false, double, or accessory inferior turbinate.

Temporal, spatial, and seasonal variations in airborne PCDD/F and dl-PCB concentrations around Bien Hoa hot spot, Vietnam, and health risk assessments.

Passive air samplers were used to monitor polychlorodibenzo-p-dioxins and dibenzofurans (PCDD/Fs) and dioxin-like polychlorobiphenyls (dl-PCBs) between 2020 and 2022 in four residential areas around Bien Hoa hot spot (BHS) including Trung Dung (TD), Tan Phong (TP), Quang Vinh (QV), and Buu Long (BL). The total toxic equivalents of PCDD/Fs and dl-PCBs (∑TEQs) were highest in the TD area, from 284 to 642 fg TEQ/PUF day. Next was the QV area, where ∑TEQs ranged from 229 to 569 fg TEQ/PUF day. Then, ∑TEQs varied from 205 to 503 fg TEQ/PUF day in the TP area. The lowest ∑TEQs were between 179 and 385 fg TEQ/PUF day in the BL area. The temporal, spatial, and seasonal variations in concentrations of PCDD/Fs and dl-PCBs were related to the prevailing wind direction and the distance from each area to the dioxin hot spot. The average ∑TEQs for all four areas surrounding BHS in the dry season (423 fg TEQ/PUF day) were 1.4 times higher than in the rainy season (303 fg TEQ/PUF day). Health risk assessments from airborne dioxin exposure were estimated using the average daily doses through inhalation (ADDI). The ADDI for residents surrounding BHS ranged from 14.6 to 208 fg TEQ/kg BW/day. The ADDI values by areas were as follows: 23.2-208 fg TEQ/kg BW/day in the TD, 18.7-184 fg TEQ/kg BW/day in the QV, 16.7-163 fg TEQ/kg BW/day in the TP, and 14.6-125 fg TEQ/kg BW/day in the BL. These ADDI values remained within and below the 10% threshold of the WHO-recommended tolerable daily intake (100-400 fg TEQ/kg BW/day). It is necessary to control the excavation activities inside the BHS and cover the temporary storage sites of dioxin-contaminated materials to minimize the emissions of PCDD/Fs and dl-PCB into the ambient air.

Alternative hybrid access in endovascular neurosurgery: Scoping review and technical considerations.

BACKGROUND: The common femoral artery and radial artery constitute the most common access sites in contemporaneous endovascular neurosurgery. Oftentimes, it may be impossible to reach the vascular target safely due to different circumstances, necessitating alternative approaches. We aim to review these "last resource" access sites described in the literature, focusing on the technical aspects as a convenient reference. METHODS: We performed a comprehensive literature search of PubMed capturing articles from 1958 to 2022. RESULTS: We identified nine alternative approaches for endovascular access, after excluding direct carotid stick: superficial temporal artery access in 60 patients, calvarial foramina access in five patients, occipital artery access in seven patients, middle meningeal artery access in six patients, vertebral artery access in 23 patients and external carotid artery, internal maxillary artery, facial artery or lingual artery in 40 patients. Indications for the use of alternative access points included tortuous or occluded vessels, small vessel calibers, or anatomic variation. Pathologies treated included dural arteriovenous fistulas, arteriovenous malformations, intracranial aneurysms, acute stroke, and intracranial stenosis. Diagnostic brain angiograms were also performed. CONCLUSIONS: Alternative vascular access routes expand the proceduralists' toolkit, enhancing the capability to manage complex cerebrovascular interventions. This review advocates for a broader understanding and consideration of these techniques, given their potential to significantly increase treatment options in neuroendovascular surgery.

Anatomical variations of origin of the internal carotid artery: Report of two cases and systematic review of the literature.

BACKGROUND: Anatomical variations of origin of the internal carotid artery (ICA) are very uncommon and may pose a diagnostic and therapeutic challenge. OBJECTIVE: We report a case of direct origin of the right ICA from the innominate artery (aplasia of common carotid artery) and a case of duplication of right ICA in healthy patients who performed duplex ultrasound (DUS) for primary cardiovascular prevention screening. METHODS: In both cases, the ultrasound scan was performed both in a transverse plane and on the longitudinal axis, and in one of the two cases, a computed tomography angiography was performed to confirm the diagnosis. A review of the current literature about anatomical variations of origin of carotid arteries was also performed. RESULTS: The most frequent congenital anomaly is represented by the aplasia of the CCA, followed by the agenesis and by the duplication of the ICA. In most cases, the anomaly is discovered occasionally and symptoms are aspecific. Diagnosis is usually confirmed through a multimodality imaging approach, including DUS of extracranial carotid arteries, magnetic resonance imaging (MRI), and computed tomographic angiography. In most cases, treatment was conservative, with pharmacological therapy aimed at the symptoms. CONCLUSION: The recognition of such variations is mandatory, particularly when the patient needs a surgical treatment that may involve the vessel with the anatomical variations.

Extraction and Physicochemical Characterization of Hydroxyapatites From Horse Humerus Bones of Different Ages (1, 3, 6, and 8 Years old) Calcined at Low Temperature.

The aim of this work is to investigate the changes in the physicochemical properties of hydroxyapatite (HAp) extracted from horse humerus bones of different ages (1, 3, 6, and 8 years) subjected to low temperature calcination (600°C). Thermal analysis revealed significant mass loss due to water, collagen, organic compounds, carbonates, and age-related magnesium out-diffusion. Higher fat content in older bones contributed to increased mass loss. Phosphorus content remained constant across age groups, while calcium and sodium showed age-related fluctuations. Magnesium levels decreased with age, emphasizing its importance for early bone development. The Ca/P ratio deviated from the stoichiometric values due to additional ions from biogenic sources. Infrared spectroscopy identified functional groups in carbonated HAp, with changes observed before and after calcination. The full width at half maximum (FWHM) of the 961 cm-1 band decreased with age, indicating improved crystalline quality. The molar absorption coefficients provided information on the changes in molecular concentration and emphasized the differences between the age groups. X-ray analysis revealed nanocrystalline HAp in all samples, with crystallite size increasing with age. Rietveld analysis showed that the lattice parameters were affected by the presence of organic material, but the lattice constants remained stable, confirming high crystallinity independent of age. TEM analysis confirmed nanocrystalline structures, with crystallite size increasing with age. SEM images showed the characteristic porosity of calcined HAp, with particle size correlating positively with age. Calcination at 600°C preserved the nanoscale properties and microcrystal formation. Raman spectroscopy confirmed the identity of HAp, with FWHM variations indicating age-related changes in crystalline quality. EHAp1 showed increased FWHM, indicating lower crystalline quality and increased trace element content.

Spatial distribution and associated factors of cesarean section in Ethiopia using mini EDHS 2019 data: a community based cross-sectional study.

Maternal health is a major public health tricky globally. Cesarean section delivery reduces morbidity and mortality when certain complications occur throughout pregnancy and labor. Cesarean section subjected to the availability and use of essential obstetric services in regional factors in Ethiopia. There was a scarcity of studies that assess the spatial distribution and associated factors of cesarean section. Consequently, this study aimed to assess the spatial variation of cesarean section and associated factors using mini EDHS 2019 national representative data. A community based cross-sectional study was conducted in Ethiopia from March to June 2019. A two-stage stratified sampling design was used to select participants. A Global Moran's I and Getis-Ord Gi* statistic hotspot analysis was used to assess the spatial distribution. Kuldorff's SaTScan was employed to determine the purely statistically significant spatial clusters. A multilevel binary logistic regression model fitted to identify factors. A total of 5753 mothers were included. More than one-fourth of mothers delivered through cesarean section at private health institutions and 54.74% were not educated. The proportion of cesarean section clustered geographically in Ethiopia and hotspot areas were observed in Addis Ababa, Oromia, Tigray, Derie Dewa, Amhara, and SNNR regions. Mothers' age (AOR = 1.07, 95% CI 1.02-1.12), mother's had secondary education (AOR = 2.113, 95% CI 1.414, 3.157), mother's higher education (2.646, 95% CI 1.724, 4.063), Muslim religion followers (AOR = 0.632, 95% CI 0.469, 0.852), poorer (AOR = 1.719, 95% CI 1.057, 2.795), middle wealth index (AOR = 1.769, 95% CI 1.073, 2.918), richer (AOR = 2.041, 95% CI 1.246, 3.344), richest (AOR = 3.510, 95% CI 2.197, 5.607), parity (AOR = 0.825, 95% CI 0.739, 0.921), and multiple pregnancies (AOR = 4.032, 95% CI 2.418, 6.723) were significant factors. Therefore, geographically targeted interventions are essential to reduce maternal and infant mortality with WHO recommendations for those Muslim, poorest and not educated mothers.