PAT (Periderm Assessment Toolkit): A Quantitative and Large-Scale Screening Method for Periderm Measurements.

The periderm is a vital protective tissue found in the roots, stems, and woody elements of diverse plant species. It plays an important function in these plants by assuming the role of the epidermis as the outermost layer. Despite its critical role for protecting plants from environmental stresses and pathogens, research on root periderm development has been limited due to its late formation during root development, its presence only in mature root regions, and its impermeability. One of the most straightforward measurements for comparing periderm formation between different genotypes and treatments is periderm (phellem) length. We have developed PAT (Periderm Assessment Toolkit), a high-throughput user-friendly pipeline that integrates an efficient staining protocol, automated imaging, and a deep-learning-based image analysis approach to accurately detect and measure periderm length in the roots of Arabidopsis thaliana. The reliability and reproducibility of our method was evaluated using a diverse set of 20 Arabidopsis natural accessions. Our automated measurements exhibited a strong correlation with human-expert-generated measurements, achieving a 94% efficiency in periderm length quantification. This robust PAT pipeline streamlines large-scale periderm measurements, thereby being able to facilitate comprehensive genetic studies and screens. Although PAT proves highly effective with automated digital microscopes in Arabidopsis roots, its application may pose challenges with nonautomated microscopy. Although the workflow and principles could be adapted for other plant species, additional optimization would be necessary. While we show that periderm length can be used to distinguish a mutant impaired in periderm development from wild type, we also find it is a plastic trait. Therefore, care must be taken to include sufficient repeats and controls, to minimize variation, and to ensure comparability of periderm length measurements between different genotypes and growth conditions.

IGF-2-mediated hypoglycemia: a case series and review of the medical therapies for refractory hypoglycemia.

Summary: Non-islet cell tumour hypoglycemia (NICTH), typically mediated by insulin-like growth factor 2 (IGF-2), is a rare but highly morbid paraneoplastic syndrome associated with tumours of mesenchymal or epithelial origin. Outside of dextrose administration and dietary modification which provide transient relief of hypoglycemia, resection of the underlying tumour is the only known cure for NICTH. Available medical therapies to manage hypoglycemia include glucocorticoids, recombinant growth hormone, and pasireotide. We report two cases of IGF-2 mediated hypoglycemia. The first was managed surgically to good effect, highlighting the importance of a timely diagnosis to maximise the likelihood of a surgical cure. The second patient had unresectable disease and was managed medically, adding to a growing number of cases supporting the efficacy of glucocorticoids and recombinant growth hormone in NICTH. Learning points: Recurrent fasting hypoglycemia in the setting of a malignancy should raise suspicion of non-islet cell tumour hypoglycemia (NICTH), which is typically mediated by IGF-2. The initial workup for NICTH should include a serum glucose, C-peptide, insulin, insulin antibodies, beta-hydroxybutyrate, IGF-2, IGF-1, and sulphonylurea screen during a spontaneous or induced hypoglycemic episode. An IGF-2/IGF-1 ratio above 10 is highly suggestive of IGF-2-mediated hypoglycemia if the IGF-2 level is normal or elevated. False positives may be seen with sepsis and cachexia as both IGF-2 and IGF-1 are subnormal in these cases. A low IGF binding protein 3 (IGFBP3), such as in renal failure, may also result in a falsely normal or low IGF-2/IGF-1 ratio. Surgical resection of the associated tumour is curative in most NICTH cases. When the tumour is unresectable, moderate-dose glucocorticoids, low-dose glucocorticoids in combination with recombinant growth hormone, and pasireotide are medical therapies with promising results in controlling NICTH.

Clinical factors and surgical decision-making when managing premenopausal women with adnexal torsion.

PURPOSE: The primary objective of this study is to identify if and which clinical factors may influence surgical decision-making when managing premenopausal women who present emergently with adnexal torsion (AT). METHODS: This retrospective cohort study was conducted at a single tertiary hospital. Medical records for all admissions for AT between 1 January 2010 and 30 June 2020 were reviewed and data regarding patient demographics, history of torsion, and the index admission were collected. Conservative surgery was defined as detorsion only or detorsion with cyst decompression. Interventional surgery was defined as ovarian cystectomy, salpingectomy, oophorectomy or salpingo-oopherectomy. RESULTS: 126 women were included for final analysis. Of the 109 women diagnosed with AT at emergency surgery, 12 were postmenopausal (all had interventional surgery). In the 97 premenopausal women, 50 (52%) underwent conservative surgery. Pregnant women were more likely to undergo conservative surgery than non-pregnant women (Relative Risk [RR] 0.20, 95% confidence interval [CI] 0.5, 0.75, p = 0.001). Women having laparoscopies were also more likely to undergo conservative surgery (RR 0.08, 95% CI 0.01, 0.53, p = 0.001) than if they had laparotomies. Although not reaching statistical significance, women were more likely to undergo laparotomy if they were febrile or if a senior gynecology consultant was involved in their care. History of torsion, age, parity and ovarian size did not alter the risk of interventional surgery. CONCLUSION: This study identified that premenopausal women who presented emergently with AT were significantly more likely to have conservative surgery if they were pregnant or if they underwent laparoscopic surgery.

Improving obesity management training in family medicine: multi-methods evaluation of the 5AsT-MD pilot course.

BACKGROUND: Quality, evidence-based obesity management training for family medicine residents is needed to better support patients. To address this gap, we developed a comprehensive course based on the 5As of Obesity Management™ (ASK, ASSESS, ADVISE, AGREE, ASSIST), a framework and suite of resources to improve residents' knowledge and confidence in obesity counselling. This study assessed the course's impact on residents' attitudes, beliefs, and confidence with obesity counselling. METHODS: The course combines lectures with a bariatric empathy suit experience, standardized and in-clinic patient practice, and narrative reflections. Using a multi-methods design we measured changes in 42 residents' attitudes, beliefs, and self-confidence and thematically analyzed the narrative reflections to understand residents' experience with the course content and pedagogy. RESULTS: Following the course, residents reported improved attitudes towards people living with obesity and improved confidence for obesity counselling. Pre/post improvement in BAOP scores (n = 32) were significant (p < .001)., ATOP scores did not change significantly. Residents showed improvement in assessing root causes of weight gain (p < .01), advising patients on treatment options (p < .05), agreeing with patients on health outcomes (p < .05), assisting patients in addressing their barriers (p < .05), counseling patients on weight gain during pregnancy, (p < .05), counseling patients on depression and anxiety (p < .01), counseling patients on iatrogenic causes of weight gain (p < .01), counseling patients who have children with obesity (p < .05), and referring patients to interdisciplinary providers for care (p < .05). Qualitative analysis of narrative reflections illustrates that experiential learning was crucial in increasing residents' ability to empathically engage with patients and to critically reflect on implications for their practice. CONCLUSION: The 5AsT-MD course has the potential to increase residents' confidence and competency in obesity prevention and management. Findings reflect the utility of the 5As to improve residents' confidence and competency in obesity management counselling.

Temporal thermometry fails to track body core temperature during heat stress.

PURPOSE: The aim of this study was to assess the accuracy of temporal scanning thermometry in monitoring internal temperature increases during passive heating. METHODS: Sixteen subjects (5 males and 11 females) underwent a whole-body passive heat stress (water-perfused suit) to increase internal temperature. Temperatures were obtained with a temporal scanner and with an ingestible-pill telemetry system that tracks intestinal temperature. Temperatures were recorded while subjects were normothermic (34 degrees C water-perfusing suit) and every 10 min during passive heating (48 degrees C water-perfusing suit). RESULTS: Heart rate (ECG), mean skin temperature (weighted six-site average), skin blood flow (laser Doppler flowmetry), and sweat rate (capacitance hygrometry) were all significantly elevated at the end of heating (all P < 0.001). Pre-heat stress temporal-derived temperature was not different from intestinal temperature (36.98 +/- 0.09 vs 37.01 +/- 0.09 degrees C, respectively, P = 0.76). However, after 30 min of heating (the greatest duration of heating completed by all subjects), temporal-derived temperature decreased to below the pre-heat stress baseline (-0.22 +/- 0.11), whereas intestinal temperature increased by 0.39 +/- 0.07 degrees C (P < 0.001 between the two methods). After 50 min of heating (N = 11), intestinal-derived internal temperature increased by 0.70 +/- 0.09 degrees C, whereas temporal-derived temperature decreased by 0.29 +/- 0.10 degrees C (P < 0.001). The group average (+/- SEM) R2 and slope between the two methods were 0.29 +/- 0.08 and -0.34 +/- 0.14, respectively. CONCLUSION: These results demonstrate that temporal scanning does not track internal temperature, as measured via intestinal temperature, during passive heating. Given these findings, it is recommended that this technique not be used to assess temperature in hyperthermic diaphoretic subjects.