A conserved GRAS-domain transcriptional regulator links meristem indeterminacy to sex determination in Ceratopteris gametophytes.

Most land plants alternate between generations of sexual gametophytes and asexual sporophytes. Unlike seed plants, fern gametophytes are free living and grow independently of their sporophytes. In homosporous ferns such as Ceratopteris, gametophytes derived from genetically identical spores exhibit sexual dimorphism, developing as either males or hermaphrodites. Males lack meristems and promote cell differentiation into sperm-producing antheridia. In contrast, hermaphrodites initiate multicellular meristems that stay undifferentiated, sustain cell division and prothallus expansion, and drive the formation of egg-producing archegonia. Once initiating the meristem, hermaphrodites secrete the pheromone antheridiogen, which triggers neighboring slower-growing gametophytes to develop as males, while the hermaphrodites themselves remain insensitive to antheridiogen. This strategy promotes outcrossing and prevents all individuals in the colony from becoming males. This study reveals that an evolutionarily conserved GRAS-domain transcriptional regulator (CrHAM), directly repressed by Ceratopteris microRNA171 (CrmiR171), promotes meristem development in Ceratopteris gametophytes and determines the male-to-hermaphrodite ratio in the colony. CrHAM preferentially accumulates within the meristems of hermaphrodites but is excluded from differentiated antheridia. CrHAM sustains meristem proliferation and cell division through conserved hormone pathways. In the meantime, CrHAM inhibits the antheridiogen-induced conversion of hermaphrodites to males by suppressing the male program expression and preventing meristem cells from differentiating into sperm-producing antheridia. This finding establishes a connection between meristem indeterminacy and sex determination in ferns, suggesting both conserved and diversified roles of meristem regulators in land plants.

Galectin-3 changes from admission to discharge and its prognostic value for in-hospital mortality in heart failure: A prospective observational study.

The aim of this study was to compare the levels of Galectin-3 (Gal-3) in heart failure patients at admission and discharge, and to evaluate the ability of Gal-3 at admission in predicting in-hospital mortality. A total of 111 patients were enrolled. Gal-3 and B-type natriuretic peptide (BNP) levels were measured at admission and discharge. Receiver operating characteristic analysis was used to determine the optimal cutoff values for Gal-3 and BNP, and logistic regression was used to assess the predictive ability of these biomarkers for in-hospital mortality. Gal-3 levels at discharge (24.08 ±â€…9.55) were significantly lower than those at admission (30.71 ±â€…11.22). The majority of patients (72.07%) experienced a decrease in Gal-3 levels, with a median reduction of 19.9% (interquartile range [IQR] 8.7-29.8). Gal-3 levels showed a weak correlation with BNP levels both at admission and discharge. Combining Gal-3 and BNP significantly improved the ability to predict in-hospital mortality, and including heart failure stage as a third predictor further improved the predictive accuracy. The optimal cutoff values for Gal-3 and BNP to predict in-hospital mortality were identified as 28.1 ng/mL and 1782.6 pg/mL, respectively, with moderate to good sensitivity and specificity. A median reduction of 19.9% of Gal-3 may indicate possibility to discharge. Our findings suggest that Gal-3 and BNP, when combined with heart failure stage, may be useful for predicting in-hospital mortality.

A Review of the Technology, Training, and Assessment Methods for the First Real-Time AI-Enhanced Medical Device for Endoscopy.

Artificial intelligence (AI) has the potential to assist in endoscopy and improve decision making, particularly in situations where humans may make inconsistent judgments. The performance assessment of the medical devices operating in this context is a complex combination of bench tests, randomized controlled trials, and studies on the interaction between physicians and AI. We review the scientific evidence published about GI Genius, the first AI-powered medical device for colonoscopy to enter the market, and the device that is most widely tested by the scientific community. We provide an overview of its technical architecture, AI training and testing strategies, and regulatory path. In addition, we discuss the strengths and limitations of the current platform and its potential impact on clinical practice. The details of the algorithm architecture and the data that were used to train the AI device have been disclosed to the scientific community in the pursuit of a transparent AI. Overall, the first AI-enabled medical device for real-time video analysis represents a significant advancement in the use of AI for endoscopies and has the potential to improve the accuracy and efficiency of colonoscopy procedures.

A novel AI device for real-time optical characterization of colorectal polyps.

Accurate in-vivo optical characterization of colorectal polyps is key to select the optimal treatment regimen during colonoscopy. However, reported accuracies vary widely among endoscopists. We developed a novel intelligent medical device able to seamlessly operate in real-time using conventional white light (WL) endoscopy video stream without virtual chromoendoscopy (blue light, BL). In this work, we evaluated the standalone performance of this computer-aided diagnosis device (CADx) on a prospectively acquired dataset of unaltered colonoscopy videos. An international group of endoscopists performed optical characterization of each polyp acquired in a prospective study, blinded to both histology and CADx result, by means of an online platform enabling careful video assessment. Colorectal polyps were categorized by reviewers, subdivided into 10 experts and 11 non-experts endoscopists, and by the CADx as either "adenoma" or "non-adenoma". A total of 513 polyps from 165 patients were assessed. CADx accuracy in WL was found comparable to the accuracy of expert endoscopists (CADxWL/Exp; OR 1.211 [0.766-1.915]) using histopathology as the reference standard. Moreover, CADx accuracy in WL was found superior to the accuracy of non-expert endoscopists (CADxWL/NonExp; OR 1.875 [1.191-2.953]), and CADx accuracy in BL was found comparable to it (CADxBL/CADxWL; OR 0.886 [0.612-1.282]). The proposed intelligent device shows the potential to support non-expert endoscopists in systematically reaching the performances of expert endoscopists in optical characterization.

Safety, clinical and laboratory characteristics of donors with thalassemia minor in living donor kidney transplant: a case series.

BACKGROUND: Due to the increasing demand for kidney transplants, sometimes donors with underlying medical conditions can be considered for living kidney donor transplant. Thalassemia is amongst the most common inherited disorders of hemoglobin globally, which is not restricted as an exclusion criterion. However, there is currently no study examine the safety and characteristics of kidney donors with thalassemia minor. METHODS: All eligible live kidney donors between 2016 and 2019 with thalassemia minor at a tertiary hospital were recruited. Baseline characteristics, clinical and laboratory outcomes were investigated. RESULTS: Fifteen donors (11 women, 55.5 ± 15.0 year-old) were included with a follow-up duration of 2 (1-4) years since operation. The most prevalent gene mutation among participants was DEL-SEA. No clinical manifestations of anemia were seen but 10 participants had mild anemia diagnosed from blood tests. Cardiovascular, liver and renal function were normal before nephrectomy. Until now, all donors are alive and maintain overall good health. Anemia condition is not affected, and the post-donation eGFR = 71.04 ± 11.54 mL/min/1.73m2 is comparable to outcomes of healthy donors reported in previous studies. Two donors are at risk of proteinuria at 1-year post-transplant with A/C ratio > 30 mg/g. CONCLUSIONS: Thalassemia minor individuals who are non-transfusion-dependent, without anemia clinical manifestations and have no contraindications to kidney donation are safe to be donors in short-term. An eGFR of at least 80 mL/min/1.73m2 should be considered to avoid low post-donation eGFR, and awareness should be raised on thalassemia donors with even mild albuminuria. Nephrectomy does not worsen thalassemia.

Managing diabetes and hypertension in chronic kidney disease.

ABSTRACT: Since 2020, several guidelines have been published to help health practitioners better manage hypertension and diabetes in patients with chronic kidney disease. Scrutiny on the inclusion of race in determining the estimated glomerular filtration rate (eGFR) as well as breakthrough research regarding the drug dapagliflozin for the treatment of patients with chronic kidney disease are discussed.

Longitudinal Evolution of Bone Microarchitecture and Bone Strength in Type 2 Diabetic Postmenopausal Women With and Without History of Fragility Fractures-A 5-Year Follow-Up Study Using High Resolution Peripheral Quantitative Computed Tomography.

Introduction: Diabetic bone disease is characterized by an increased fracture risk which may be partly attributed to deficits in cortical bone quality such as higher cortical porosity. However, the temporal evolution of bone microarchitecture, strength, and particularly of cortical porosity in diabetic bone disease is still unknown. Here, we aimed to prospectively characterize the 5-year changes in bone microarchitecture, strength, and cortical porosity in type 2 diabetic (T2D) postmenopausal women with (DMFx) and without history of fragility fractures (DM) and to compare those to nondiabetic fracture free controls (Co) using high resolution peripheral quantitative computed tomography (HR-pQCT). Methods: Thirty-two women underwent baseline HR-pQCT scanning of the ultradistal tibia and radius and a FU-scan 5 years later. Bone microarchitectural parameters, including cortical porosity, and bone strength estimates via µFEA were calculated for each timepoint and annualized. Linear regression models (adjusted for race and change in BMI) were used to compare the annualized percent changes in microarchitectural parameters between groups. Results: At baseline at the tibia, DMFx subjects exhibited the highest porosity of the three groups (66.3% greater Ct.Po, 71.9% higher Ct.Po.Volume than DM subjects, p < 0.022). Longitudinally, porosity increased significantly over time in all three groups and at similar annual rates, while DMFx exhibited the greatest annual decreases in bone strength indices (compared to DM 4.7× and 6.7× greater decreases in failure load [F] and stiffness [K], p < 0.025; compared to Co 14.1× and 22.2× greater decreases in F and K, p < 0.020). Conclusion: Our data suggest that despite different baseline levels in cortical porosity, T2D women with and without fractures experienced long-term porosity increases at a rate similar to non-diabetics. However, the annual loss in bone strength was greatest in T2D women with a history of a fragility fractures. This suggests a potentially non-linear course of cortical porosity development in T2D bone disease: major porosity may develop early in the course of disease, followed by a smaller steady annual increase in porosity which in turn can still have a detrimental effect on bone strength-depending on the amount of early cortical pre-damage.

Acute kidney injury: Challenges and opportunities.

Acute kidney injury (AKI) can be a devastating diagnosis for any patient and can increase mortality during hospitalization. There can be long-term consequences for those who survive the initial insult. This article discusses AKI and its implications for nurses.

Successful secondary thromboprophylaxis with direct oral anticoagulants for a patient with catastrophic antiphospholipid syndrome: A case report.

RATIONALE: Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening condition of antiphospholipid syndrome (APS). Treatment and management of CAPS remain challenging and the mortality rate is approximately 50% among cases. We describe a successfully treated case of a CAPS patient who had undergone massive bowel resection due to obstruction of superior mesenteric artery. PATIENT CONCERNS: A 40-year-old male patient was admitted to our hospital with acute abdominal pain, melena, and a history of deep vein thrombosis in both legs for over 10 years, there was no previous diagnosis of APS. DIAGNOSIS: The patient was diagnosed as CAPS with bowel necrosis due to obstruction of superior mesenteric artery based on the presence of antiphospholipid antibodies, computed tomography scan, and histopathological examination. INTERVENTIONS: Emergency surgery was performed to remove approximately 6 meters of the necrotic small intestine, of which the length of the remaining small intestine was 40 cm from the duodenum and 80 cm from the ileocaecal valve. Anticoagulants were prescribed with low molecular weight heparin. After discharging, APS was managed with direct oral anticoagulants (DOACs) for secondary thromboprophylaxis because the patient was unable to reach target International Normalized Ratio (INR) with vitamin K antagonists (VKAs). OUTCOMES: During 24 months of follow-up until now, the patient did not develop new thrombosis or relapse CAPS and his state remained stable. LESSONS: While VKAs is amongst the most important and fundamental treatment, physicians should be aware that VKAs are absorbed via the small intestine. For CAPS cases who had undergone massive bowel resection, DOACs is a reasonable alternative which has been found to be as safe and effective as VKAs in terms of thrombosis prevention.

The validity of reticulocyte hemoglobin content and percentage of hypochromic red blood cells for screening iron-deficiency anemia among patients with end-stage renal disease: a retrospective analysis.

BACKGROUND: Early detection of iron-deficiency anemia (IDA) can enhance the efficiency and effectiveness of clinical treatment and quality of life for end-stage renal disease (ESRD) patients. This study aimed to evaluate the validity of CHr and %Hypo in screening IDA among ESRD patients and compare their performance with screening IDA among non-ESRD patients. METHOD: A retrospective analysis of 312 participants was conducted at Cho Ray Hospital, Vietnam, including healthy control participants and ESRD patients. Receiver operator characteristics curves and the area under the curve (AUC) of models were used to evaluate the performance of CHr, %Hypo. Optimal cut-off values were determined using Youden's index. RESULTS: Detecting IDA in ESRD patients is more complicated, as the screening performance of CHr and %Hypo in predicting IDA among ESRD patients were lower than non ESRD group, but still reasonable with AUC = 0.748 (95% CI: 0.656-0.840, power = 0.997) and 0.740 (95% CI: 0.647-0.833, power = 0.996), respectively. Cut-off values of CHr < 31.5 pg and %Hypo> 10.0 pg are recommended to obtain optimal screening ability for Vietnamese ESRD patients. CONCLUSION: CHr and %Hypo appears to be useful tools for screening IDA among both non ESRD and ESRD patients. The low cost and accessible of the two markers encourage their utility as effective screening tools in clinical practice.

Acute kidney injury: Challenges and opportunities.

Community-acquired acute kidney injury (CA-AKI) can be a devastating diagnosis for any patient and can increase mortality during hospitalization. There can be long-term consequences for those who survive the initial insult. This article discusses CA-AKI and its implications for APRNs.

Artificial Intelligence for the Objective Evaluation of Acne Investigator Global Assessment.

INTRODUCTION: The evaluation of Acne using ordinal scales reflects the clinical perception of severity but has shown low reproducibility both intra- and inter-rater. In this study, we investigated if Artificial Intelligence trained on images of Acne patients could perform acne grading with high accuracy and reliabilities superior to those of expert physicians. METHODS: 479 patients with acne grading ranging from clear to severe and sampled from three ethnic groups participated in this study. Multi-polarization images of facial skin of each patient were acquired from five different angles using the visible spectrum. An Artificial Intelligence was trained using the acquired images to output automatically a measure of Acne severity in the 0-4 numerical range of the Investigator Global Assessment (IGA). RESULTS: The Artificial Intelligence recognized the IGA of a patient with an accuracy of 0.854 and a correlation between manual and automatized evaluation of r=0.958 (P less than .001). DISCUSSION: This is the first work where an Artificial Intelligence was able to directly classify acne patients according to an IGA ordinal scale with high accuracy, no human intervention and no need to count lesions. J Drugs Dermatol. 2018;17(9):1006-1009.

Teleradiology system accessible through a common web browser.

PURPOSE: To describe a teleradiology system accessible via a PC and a common web browser. MATERIAL AND METHODS: A dedicated system is connected to several radiological imagers (DR, US, CT, MR) with DICOM standard and TCP/IP protocol. The images are visualised in a common web browser on a remote PC by connecting to the dedicated web-site. Compressed images are visualised on a web page. Special toolbars allow specific operations to be performed on the images (brightness-contrast, zoom, distance measurement and ROI defining) and the communication with the radiological centre. RESULTS: The graphic interface is user-friendly and does not require any special knowledge, except for basic PC and internet surfing. Image compression can be set to preserve image quality, and image transfer is fast. CONCLUSIONS: The system presented overcomes the limitations of conventional teleradiology systems since it requires no special network or dedicated software, allowing for visualisation of a radiological examination on a PC and a common web browser.