Thyroid B-Cell Lymphoma in the Background of Hashimoto's Thyroiditis: A Case Report and Literature Review.

Primary thyroid lymphoma (PTL) is a rare type of thyroid cancer, comprising less than 5% of all thyroid cancer cases. PTL includes subtypes like diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue lymphoma (MALT). The connection between PTL and autoimmune diseases of the thyroid, particularly Hashimoto's thyroiditis, has gained recognition in recent years. Studies have indicated an increased incidence of PTL among individuals with Hashimoto's thyroiditis. However, effectively recognizing and managing PTL in the context of autoimmune thyroid diseases remains challenging. Further research and clinical experience are needed to develop comprehensive strategies for early detection and optimal management of this complex condition. In a case involving an 88-year-old female diagnosed with diffuse large B-cell lymphoma, she presented with a complaint of persistent neck swelling for five years. The patient also experienced symptoms such as dysphagia, hoarseness of voice, obstructive sleep apnea, and choking attacks. Surgical resection of the neck swelling was successfully performed, and the patient was referred to the oncology department for further treatment. Thyroid B-cell lymphoma is an exceedingly rare form of thyroid cancer, typically identified in individuals who have a history of Hashimoto's thyroiditis. The prognosis for thyroid B-cell lymphoma is generally unfavorable, and surgical intervention remains the primary treatment approach for such cases.

Rate and Causes of 30-day Unplanned Readmission/Return Following Head and Neck Surgery at a Tertiary Care Center in Saudi Arabia.

Background: Identifying and targeting common preventable causes of 30-day hospital readmissions could help improve survival rates and reduce the healthcare burden. Objective: To determine the rate and causes of unplanned hospital return/readmission to the Outpatient Department (OPD) or Emergency Department (ED) within 30 days after discharge following head and neck surgery (HNS) at a tertiary hospital in Western Saudi Arabia. Methods: This retrospective study included all adult patients (aged ≥18 years) who had undergone HNS at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between January 2015 and December 2022 and returned to the OPD or ED within 30 days of being discharged. Results: Of 1041 patients who had undergone HNS, 84 (8.1%) returned to the hospital within 30 days after discharge: 63 (6.1%) to the OPD and 21 (2.0%) to the ED. A total of 9 (0.9%) patients were readmitted as inpatients, most commonly for infections (33.3%) and neurological symptoms, including weakness and seizures (22.2%). For OPD visits, common causes were wound swelling (25.4%) and neurological symptoms (17.5%). For ED returns, frequent causes were neurological symptoms (23.8%) and surgical site bleeding (19.1%). Readmission was associated with intensive care unit (ICU) admission during the primary hospital stay (P = 0.003) and higher preoperative baseline health burdens when examined using the American Society of Anesthesiology score (P = 0.022), the Cumulative Illness Rating Scale (P = 0.007), and the Charlson Comorbidity Index (CCI) (P = 0.006). Conclusion: The rate of 30-day unplanned hospital return following head and neck surgery was 6.1% and 2.0% through the OPD and the ED, respectively; 0.9% were readmitted as inpatients. Common causes of return included wound swelling, infections, bleeding, and neurological symptoms.

Targeted modification of furan-2-carboxaldehydes into Michael acceptor analogs yielded long-acting hemoglobin modulators with dual antisickling activities.

Sickle cell disease (SCD) is the most common genetic disorder, affecting millions of people worldwide. Aromatic aldehydes, which increase the oxygen affinity of human hemoglobin to prevent polymerization of sickle hemoglobin and inhibit red blood cell (RBC) sickling, have been the subject of keen interest for the development of effective treatment against SCD. However, the aldehyde functional group metabolic instability has severly hampered their development, except for voxelotor, which was approved in 2019 for SCD treatment. To improve the metabolic stability of aromatic aldehydes, we designed and synthesized novel molecules by incorporating Michael acceptor reactive centers into the previously clinically studied aromatic aldehyde, 5-hydroxymethylfurfural (5-HMF). Eight such derivatives, referred to as MMA compounds were synthesized and studied for their functional and biological activities. Unlike 5-HMF, which forms Schiff-base interaction with αVal1 nitrogen of hemoglobin, the MMA compounds covalently interacted with ßCys93, as evidenced by reverse-phase HPLC and disulfide exchange reaction, explaining their RBC sickling inhibitory activities, which at 2 mM and 5 mM, range from 0% to 21% and 9% to 64%, respectively. Additionally, the MMA compounds showed a second mechanism of sickling inhibition (12%-41% and 13%-62% at 2 mM and 5 mM, respectively) by directly destabilizing the sickle hemoglobin polymer. In vitro studies demonstrated sustained pharmacologic activities of the compounds compared to 5-HMF. These findings hold promise for advancing SCD therapeutics.

Total laryngectomy and readmission: causes, rates and predictors.

BACKGROUND: Total laryngectomy (TL) is a complex procedure, and patients undergoing TL are at high risk for readmission, which exposes them to hospital-acquired complications. Readmission rate is a metric for quality of care. We aimed to identify the rate, causes, and predictors of hospital readmission within 60 days after discharge following TL. METHODS: This is a 12-year retrospective study where we included all patients undergoing TL in a single tertiary care center between 2008 and 2022. Patient charts were reviewed for demographics, comorbidities, and causes for readmission. RESULTS: Of 83 patients who underwent TL, 12 (14.50%) were readmitted within 60 days. Common causes were surgical site infection (33.33%) and mucocutaneous fistula (25%). Significant predictors for readmission were tobacco use (P = 0.003), African ethnicity (P = 0.004), being unmarried (P < 0.001), lower preoperative serum albumin (P < 0.001), higher preoperative TSH (P = 0.03), higher preoperative neutrophil count (P = 0.035), higher American Society of Anesthesiology (ASA) score (P = 0.028), and higher Cumulative Illness Rating Scale (CIRS) score (P = 0.029). CONCLUSION: One in every seven patients were readmitted following TL. Frequent causes include wound infection and fistulas. Predictors include preoperative hypoalbuminemia, hypothyroidism, African ethnicity, being unmarried, tobacco use, and a higher baseline burden of comorbidities. Such factors can be targeted to reduce hospital readmission rates.

Analyzing Surface Roughness Variations in Material Extrusion Additive Manufacturing of Nylon Carbon Fiber Composites.

In recent years, fused deposition modeling (FDM) based on material extrusion additive manufacturing technology has become widely accepted as a cost-effective method for fabricating engineering components with net-shapes. However, the limited exploration of the influence of FDM process parameters on surface roughness parameters, i.e., Ra (average surface roughness), Rq (root mean square surface roughness), and Rz (maximum height of the profile) across different sides (bottom, top, and walls) poses a challenge for the fabrication of functional parts. This research aims to bridge the knowledge gap by analyzing surface roughness under various process parameters and optimizing it for nylon carbon fiber printed parts. A definitive screening design (DSD) was employed for experimental runs. The Pareto chart highlighted the significant effects of layer height, part orientation, and infill density on all surface roughness parameters and respective sides. The surface morphology was analyzed through optical microscopy. Multi-response optimization was performed using an integrated approach of composited desirability function and entropy. The findings of the present study hold significant industrial applications, enhancing the quality and performance of 3D printed parts. From intricate prototypes to durable automotive components, the optimized surfaces contribute to production of functional and visually appealing products across various sectors.

Estimating ground-level PM2.5 using subset regression model and machine learning algorithms in Asian megacity, Dhaka, Bangladesh.

Fine particulate matter (PM2.5) has become a prominent pollutant due to rapid economic development, urbanization, industrialization, and transport activities, which has serious adverse effects on human health and the environment. Many studies have employed traditional statistical models and remote-sensing technologies to estimate PM2.5 concentrations. However, statistical models have shown inconsistency in PM2.5 concentration predictions, while machine learning algorithms have excellent predictive capacity, but little research has been done on the complementary advantages of diverse approaches. The present study proposed the best subset regression model and machine learning approaches, including random tree, additive regression, reduced error pruning tree, and random subspace, to estimate the ground-level PM2.5 concentrations over Dhaka. This study used advanced machine learning algorithms to measure the effects of meteorological factors and air pollutants (NOX, SO2, CO, and O3) on the dynamics of PM2.5 in Dhaka from 2012 to 2020. Results showed that the best subset regression model was well-performed for forecasting PM2.5 concentrations for all sites based on the integration of precipitation, relative humidity, temperature, wind speed, SO2, NOX, and O3. Precipitation, relative humidity, and temperature have negative correlations with PM2.5. The concentration levels of pollutants are much higher at the beginning and end of the year. Random subspace is the optimal model for estimating PM2.5 because it has the least statistical error metrics compared to other models. This study suggests ensemble learning models to estimate PM2.5 concentrations. This study will help quantify ground-level PM2.5 concentration exposure and recommend regional government actions to prevent and regulate PM2.5 air pollution. Supplementary Information: The online version contains supplementary material available at 10.1007/s11869-023-01329-w.

Clinicopathological and Immunohistochemistry Study of a Long Survivor of Giant Cell Glioblastoma in a Patient With Neurofibromatosis 1: Case Report.

Glioblastoma multiforme (IDH wild type) is an aggressive glial tumor of astrocytic origin (WHO-grade 4) with a two-year median survival period. Patients who live more than three years are considered as long survivors. In this study, we present a long survivor of a known case of neurofibromatosis type 1 who developed GBM of the giant cell type at age 14 years, and now the patient, at age 28, has been cancer-free for more than 14 years.

YouTube as a source of information for retinopathy of prematurity in the Arabic language.

Retinopathy of prematurity (ROP) is a leading cause of blindness in infants thus it is important to raise awareness about this disease. As online platforms are a popular source of medical information; the purpose of this study is to evaluate the credibility of the content of YouTube videos on ROP in the Arabic language. The first 40 relevant videos were included and were independently reviewed by two ophthalmologists employing six assessment tools: reliability, accuracy, quality, comprehensiveness, overall viewer experience, and usefulness. Out of the 40 videos that were analysed, only 29 were considered useful. The mean DISCERN score of the videos was 32 indicating poor quality. Furthermore, 70% of the videos were completely accurate, but only 5% were fully comprehensive. Regarding the global quality score, only four videos were of excellent quality/flow (10%), while 15 were generally poor with the poor flow (37.5%). Viewer experience was assessed as fair to very poor in 22 videos (55%). The overall quality of the content in YouTube videos was poor, rendering this platform an unreliable source of information about ROP. However, given its high level of engagement, the medical community could hone its potential for raising awareness about ROP by creating entertaining useful content.

Design, Synthesis, and Investigation of Novel Nitric Oxide (NO)-Releasing Aromatic Aldehydes as Drug Candidates for the Treatment of Sickle Cell Disease.

Sickle cell disease (SCD) is caused by a single-point mutation, and the ensuing deoxygenation-induced polymerization of sickle hemoglobin (HbS), and reduction in bioavailability of vascular nitric oxide (NO), contribute to the pathogenesis of the disease. In a proof-of-concept study, we successfully incorporated nitrate ester groups onto two previously studied potent antisickling aromatic aldehydes, TD7 and VZHE039, to form TD7-NO and VZHE039-NO hybrids, respectively. These compounds are stable in buffer but demonstrated the expected release of NO in whole blood in vitro and in mice. The more promising VZHE039-NO retained the functional and antisickling activities of the parent VZHE039 molecule. Moreover, VZHE039-NO, unlike VZHE039, significantly attenuated RBC adhesion to laminin, suggesting this compound has potential in vivo RBC anti-adhesion properties relevant to vaso-occlusive events. Crystallographic studies show that, as with VZHE039, VZHE039-NO also binds to liganded Hb to make similar protein interactions. The knowledge gained during these investigations provides a unique opportunity to generate a superior candidate drug in SCD with enhanced benefits.

Exploring the Application Sphere of the Internet of Things in Industry 4.0: A Review, Bibliometric and Content Analysis.

This paper aims to comprehensively review 891 documents in the Scopus database about Internet of Things (IoT) in Ind 4.0 to understand the historical growth, current state, and potential expansion trend. From 2014 to 2020, a systematic methodology gathered information on IoT in Ind 4.0 documents in various Scopus databases. The relevant IoT research in Ind 4.0 documents is provided, and their types, publications, citations, and predictions are discussed. The VOSviewer 1.16.6 and Biblioshiny 2.0 applications display IoT status in Ind 4.0 publications for visualization research. The citation review aims to find the most prominent and influential authors, sources, papers, countries, and organizations. For citation analysis and ranking, document selection criteria were well defined. The author keywords, index keywords, and text data content analysis were used to identify the hotspots and development trends. The yearly IoT in Ind 4.0 article publications presented a speedily increasing trend, and a curve was fitted employing an exponential function. The paper "Intelligent manufacturing in the context of Industry 4.0: a review" was rated first with 754 citations. With 1629 citations, the "International Journal of Production Research" was ranked #1 along with Wan J. The South China University of Technology in Guangzhou, China, was placed first along with the United States as the most prolific and influential country. 'Industry 4.0' appeared the first time in 2014 with an application of IoT in Ind 4.0 with an overall appearance of 528, followed by the 'internet of things' in 2015, three times with a total count of 220 up to 2020. The IoT in Ind 4.0 assessment and bibliometric analysis intended to provide intellectuals a broad perspective working in IoT in Ind 4.0. Scholars should understand the hotspots in this area as soon as possible. This is also the first paper to thoroughly use bibliometric research to examine the IoT in Ind 4.0 literature. It will assist researchers of IoT in Ind 4.0 in expanding their knowledge and quickly comprehending the development status and pattern.

Somatosensory network functional connectivity differentiates clinical pain phenotypes in diabetic neuropathy.

AIMS/HYPOTHESIS: The aim of this work was to investigate whether different clinical pain phenotypes of diabetic polyneuropathy (DPN) are distinguished by functional connectivity at rest. METHODS: This was an observational, cohort study of 43 individuals with painful DPN, divided into irritable (IR, n = 10) and non-irritable (NIR, n = 33) nociceptor phenotypes using the German Research Network of Neuropathic Pain quantitative sensory testing protocol. In-situ brain MRI included 3D T1-weighted anatomical and 6 min resting-state functional MRI scans. Subgroup differences in resting-state functional connectivity in brain regions involved with somatic (thalamus, primary somatosensory cortex, motor cortex) and non-somatic (insular and anterior cingulate cortices) pain processing were examined. Multidimensional reduction of MRI datasets was performed using a machine-learning approach to classify individuals into each clinical pain phenotype. RESULTS: Individuals with the IR nociceptor phenotype had significantly greater thalamic-insular cortex (p false discovery rate [FDR] = 0.03) and reduced thalamus-somatosensory cortex functional connectivity (p-FDR = 0.03). We observed a double dissociation such that self-reported neuropathic pain score was more associated with greater thalamus-insular cortex functional connectivity (r = 0.41; p = 0.01) whereas more severe nerve function deficits were more related to lower thalamus-somatosensory cortex functional connectivity (r = -0.35; p = 0.03). Machine-learning group classification performance to identify individuals with the NIR nociceptor phenotype achieved an accuracy of 0.92 (95% CI 0.08) and sensitivity of 90%. CONCLUSIONS/INTERPRETATION: This study demonstrates differences in functional connectivity in nociceptive processing brain regions between IR and NIR phenotypes in painful DPN. We also establish proof of concept for the utility of multimodal MRI as a biomarker for painful DPN by using a machine-learning approach to classify individuals into sensory phenotypes.

Frameshift variant in MITF gene in a large family with Waardenburg syndrome type II and a co-segregation of a C2orf74 variant.

Waardenburg syndrome (WS) is a hereditary disorder affecting the auditory system and pigmentation of hair, eyes, and skin. Different variants of the disease exist with the involvement of mutation in six genes. The aim of the study is to identify the genetic defects underlying Waardenburg syndrome in a large family with multiple affected individuals. Here, in this study, we recruited a large family with eleven affected individuals segregating WS type 2. We performed whole genome SNP genotyping, whole exome sequencing and segregation analysis using Sanger approach. Whole genome SNP genotyping, whole exome sequencing followed by Sanger validation of variants of interest identified a novel single nucleotide deletion mutation (c.965delA) in the MITF gene. Moreover, a rare heterozygous, missense damaging variant (c.101T>G; p.Val34Gly) in the C2orf74 has also been identified. The C2orf74 is an uncharacterized gene present in the linked region detected by DominantMapper. Variants in MITF and C2orf74 follows autosomal dominant segregation with the phenotype, however, the variant in C2orf74 is incompletely penetrant. We proposed a digenic inheritance of variants as an underlying cause of WS2 in this family.

Marginal adaptation of mineral trioxide aggregate (MTA) to root dentin surface with orthograde/retrograde application techniques: A microcomputed tomographic analysis.

BACKGROUND: Achieving a good apical seal for root canals is known to be associated with good mineral trioxide aggregate (MTA) adaptation to dentin. AIMS: This study aims to compare the marginal adaptation of MTA with root dentin between orthograde and retrograde application techniques using microcomputed tomography (micro-CT) analysis. SETTINGS AND DESIGN: Fifty-two single-rooted human teeth were divided into four equal groups: (Group 1) Retrograde MTA (RMTA), (Group 2) Orthograde MTA (OMTA), (Group 3) Etched RMTA (ERMTA), and (Group 4) Etched OMTA (EOMTA). MATERIALS AND METHODS: For Group 1, 3-mm retrograde cavities were prepared and filled with MTA. For Group 2, the apical 6 mm of the canals were filled with MTA and sealed with sealer cement and warm gutta-percha. In Groups 3 and 4, canals were treated the same as Groups 1 and 2, respectively, except that before placing the MTA, canals were irrigated with 17% ethylenediaminetetraacetic acid (EDTA). After 48 hours, all the teeth were analyzed using a micro-CT scanner. STATISTICAL ANALYSIS: Mean dentin-MTA contact and the mean length and width of each gap was analysed using one-way analysis of variance (ANOVA). Statistical significance was set at an α level of 5%. RESULTS: No significant difference in gap volumes was observed in the dentin-MTA adaptation in both orthograde and retrograde application techniques. However, significant difference in the gap volumes was observed between RMTA and ERMTA (P = 0.045). Etching significantly improved the MTA-Dentin adaptation (P < 0.05). The type of application technique did not significantly improve the dentin-MTA adaptation, instead with the use of 17% EDTA, a significant improvement could be achieved. CONCLUSION: Within the limitations of the present study, it concludes that MTA adaptation to dentin tooth structure is not significantly different between an orthograde and retrograde approach. However, the use of EDTA significantly improved the MTA-Dentin adaptation.

A novel missense homozygous inactivating mutation in the fourth transmembrane helix of the luteinizing hormone receptor in leydig cell hypoplasia.

Loss-of-function mutations/inactivating mutations of the human chorionic gonadotropin/luteinizing hormone receptor (hCG/LHR), a G-protein coupled receptor, lead to impaired Leydig cell differentiation. Leydig cell hypoplasia/agenesis/dysplasia (LCH) is one of the causes of male pseudohermaphroditism (MPH). We studied a 19-year-old MPH patient with female phenotype and 46,XY karyotype. Testicular histology and hormonal profile of the patient is typical of LCH. Nucleotide sequencing of exon 11 of hLHR identified a novel T1505C transversion mutation. The mutation is homozygous in the patient and is heterozygous in both parents. The single base mutation caused the substitution of a conserved leucine at 502 position to proline in transmembrane helix (TM) IV of the hLHR. This is the first LCH causing mutation identified in TM IV of the hLHR. Expression study of the mutated hLHR in human embryonic kidney (HEK)293 cells showed reduced cAMP production and ligand binding. Receptor trafficking was not affected by the mutation when the green fluorescence protein conjugated mutated receptor was expressed in HEK293 cells. The mutation caused inactivation of the hLHR and resulted in LCH in the patient.