An 8-Year-Old Boy With Hepatic Embryonal Sarcoma Managed With Surgical Resection.

The extent of hepatic tumors in childhood differs from that found in older age groups. Some of these tumors are believed to be quite rare like undifferentiated embryonal sarcoma of the liver (UESL). The challenge in diagnosis arises from the nonspecific clinical, biochemical, and radiological features, with definitive diagnosis requiring pathological confirmation following surgical excision. Treatment options with neoadjuvant chemotherapy and surgical resection with satisfactory outcomes have been reported in the literature as well as in our case. We present the case of an 8-year-old boy who initially presented with nonspecific symptoms and was diagnosed with UESL. Following a multidisciplinary team discussion, he was treated with chemotherapy and surgical resection. Post-resection follow-up with MRI revealed stable findings.

Association between postoperative complications and hospital length of stay: a large-scale observational study of 4,495,582 patients in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) registry.

BACKGROUND: Precise estimates of risk-adjusted increases in postoperative length of stay (LOS) associated with postoperative complications across a range of complications and operations are not available in the existing literature. METHODS: Associations between preoperative characteristics, postoperative complications and postoperative LOS were tested using medians, interquartile ranges, and nonparametric rank sum tests in a retrospective cohort study using the 2005-2018 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) dataset. A negative binomial model was used with postoperative LOS as the dependent variable and preoperative characteristics and postoperative complications as independent variables. The model was applied to estimate each patient's postoperative LOS with and without each postoperative complication to measure the association between each complication and risk-adjusted change in postoperative LOS. RESULTS: A total of 4,495,582 patients were included. After risk-adjustment, occurrence of each postoperative complication was associated with significantly increased postoperative LOS (between + 3.9 and + 20.1 days, p < 0.0001). The longest risk-adjusted postoperative LOS increases were associated with prolonged ventilator use (+ 20.1 days), wound disruption (+ 19.4 days), and acute renal failure (+ 17.1 days). CONCLUSION: Occurrence of any postoperative complication was associated with increased risk-adjusted postoperative LOS. Degree of increase varied by complication. These data could be useful for patient counseling, allocation of resources, discharge planning, and quality improvement efforts.

Adult Simultaneous Cochlear Implantation: Local Anesthesia.

Purpose: Cochlear implant (CI) surgery is conventionally done under general anesthesia (GA). However, many patients are unable to undergo GA due to various reasons, raising the need for an alternative safe option. CI under local anesthesia is feasible and safely done in patients who can't tolerate GA. This approach allows for device fitting immediately after surgery. This study aims to evaluate simultaneous bilateral cochlear implant (BiCI) surgery performed under local anesthesia with sedation in adults. To our knowledge, this is the largest cohort of patients who underwent this approach. Methods: This is a retrospective chart review in a tertiary center. We included all adult patients who underwent simultaneous BiCI under local anesthesia with sedation from 2018 to 2024. The feasibility of BiCI under local anesthesia with sedation was assessed through clinical, surgical, audiological, and patient questionnaire data. Results: Six patients underwent simultaneous BiCI with local anesthetic and sedation. Mean age was 41.7 ± 16.0, comprising 66.7% male and 33.3% female. No intraoperative problems were encountered. All woke up from sedation without any agitation or difficulties. Their recovery was uneventful. No dizziness, nausea, or vomiting were reported. The device was activated immediately postoperatively. Pure tone audiometry, speech reception threshold, and word recognition score were significantly improved. Positive experiences were reported in all patients. Conclusion: Bilateral simultaneous cochlear implantation under local anesthesia in adults is achievable, through a multidisciplinary approach. This approach is a potential alternative option for some patients and could optimize their hearing rehabilitation.

Placement of transurethral urinary drainage catheter using microwire in a newborn with posterior urethral valve: A better alternative to suprapubic catheterization.

Posterior urethral valves (PUV) present significant challenges in neonatal urinary management, often indicating the use of a suprapubic catheter (SPC). However, complications associated with SPC, coupled with specific contraindications call for alternative approaches. Here, we present a case of successful transurethral catheterization in a 1-day-old premature male infant with PUV, utilizing bedside Ultrasound without anesthesia, effectively alleviating the need for a SPC. The procedure involved careful wire insertion and subsequent catheter placement, facilitating urine drainage, and enabling a micturating cystourethrogram (MCUG) using the same access point. By avoiding SPC-related risks and allowing for essential diagnostic procedures, this approach presents itself as a less invasive and possibly better initial option, particularly in cases where SPC may pose complications. Our findings suggest that ultrasound-guided transurethral catheterization offers a minimally invasive and effective alternative to SPC, proving its potential to enhance patient care and outcomes in challenging PUV cases.

Unveiling the anticancer potential of novel spirooxindole-tethered pyrazolopyridine derivatives.

In the current medical era, human health is confronted with various challenges, with cancer being a prominent concern. Therefore, enhancing the therapeutic arsenal for cancer with a constant influx of novel molecules that selectively target tumor cells while displaying minimal toxicity toward normal cells is imperative. This study delves into the antiproliferative and EGFR kinase inhibitory activities of newly reported spirooxindole-pyrazolo[3,4-b]pyridine derivatives 8a-h and 10a-h. The inhibitory effects on the growth of human cancer cell lines A-549 (lung carcinoma), Panc-1 (pancreatic carcinoma), and A-431 (skin epidermoid carcinoma) were evaluated, and the SAR has been clarified through analysis. With IC50 values in the single-digit micromolar range, compounds 8b, 8d, 10a-b, and 10d were shown to be the most effective antiproliferative candidates against the studied cancer cell lines. They also exerted negligible cytotoxicity (with selectivity scores between 8.63 and 30.02) against the human lung MRC5 cell line. Additionally, we investigated the potential inhibitory action of compounds 8b, 8d, 10a-b, and 10d on EGFR and VEGFR-2. 10a was this investigation's most effective EGFR inhibitor, with an IC50 value of 0.54 µM. Ultimately, the molecular docking analysis of congener 10a highlighted its effective suppression of EGFR by examining its binding mode and docking score compared to Erlotinib. These findings underscore the potential of spirooxindole-pyrazolo[3,4-b]pyridine derivatives as promising anticancer agents targeting EGFR kinase.

Exploring pathogenic SNPs and estrogen receptor alpha interactions in breast cancer: An in silico approach.

The estrogen receptor 1 gene (ESR1) plays a crucial role in breast and mammary development in humans. Alterations such as gene amplification, genomic rearrangements, and missense mutations in the ESR1 gene are reported to increase the risk of breast cancer in humans. The purpose of this study is to analyze the missense mutations and molecular modeling of ESR1, focusing on the pathogenic SNP H516N, for a better understanding of disease risk and future benefits for therapeutic benefits. This SNP was selected based on its location in the binding pocket of ESR1 and its predicted impact on drug binding. The in silico analysis was performed by applying various computational approaches to identify highly pathogenic SNPs in the binding pocket of ESR1. The effect of the SNP was explored through docking and intra-molecular interaction studies. All SNPs in ESR1 were identified followed by the identification of the highly pathogenic variant located in the binding pocket of ESR1. The mutant model of the pathogenic SNP H516N was generated, and hydroxytamoxifen was docked with the wild-type and the mutant model. The mutant model lost the formation of stable hydrogen bonds with the active site residues and hydroxytamoxifen, which may result in reduced binding affinity and therefore, will predict the patient's response to estrogenic inhibitors.

Pigmented Bowen's Disease: A Case Report in Saudi Arabia.

Bowen's disease (BD) is an in situ squamous cell carcinoma of the epidermis with multiple etiologies and a high incidence among Caucasians. It commonly occurs in photo-exposed areas of the skin, although other sites can also be affected. Most lesions are solitary, and their morphology can vary based on the lesion's age, origin, and degree of keratinization. A 50-year-old female from Saudi Arabia presented to the dermatology clinic with a three-year history of slowly enlarging skin lesions on the left side of her chest. Initially, the lesion appeared three years ago, but she observed changes and a darkening in color over the past year, accompanied by mild pain and itching. On examination, the lesion was a 2 × 2 cm, well-defined, unevenly pigmented brown-black plaque with a dispersed pigment pattern and irregular borders with globularity on the left side of the upper chest. A 4 mm punch biopsy was taken from the most pigmented area and sent for histopathological examination, which confirmed the diagnosis of pigmented BD.

Large transethmoidal meningoencephalocele in a neonate involving three discrete defects in lamina cribriform: A case report.

Background: Intranasal meningoencephaloceles are rarely encountered in pediatric neurosurgery. The symptoms and clinical features may mimic those of nasal polyps or dermoid cysts. Transethmoidal meningoencephalocele is a rare congenital meningoencephalocele of the anterior skull base with diverse clinical presentation. The appropriate surgical intervention is chosen according to the meningoencephalocele type and location. Radiological examinations such as computed tomography and magnetic resonance imaging are helpful for the differential diagnosis of the encephalocele sac and localization of the cranial bone defect. Case Description: We are reporting a case of basal meningoencephalocele of the transethmoidal type, which was discovered in a 20-day-old boy presenting with cerebrospinal fluid rhinorrhea, respiratory distress, difficulty in feeding, and meningitis. The preoperative images showed a large herniated intranasal sac with bony discontinuity of the cribriform plate; however, three discrete defects of the cribriform plate with their related discrete herniated sacs were identified intraoperatively. Two staged surgeries were performed in succession: transcranial to separate the sacs from the cranial cavity and seal the anterior fossa floor, followed by transnasal to remove the remnant of the intranasal sacs. Patient symptoms and signs markedly improved after the surgeries. Conclusion: We highlight the need for urgent intervention at a very young age if the clinical presentation mandates, and also the importance of meticulous intraoperative identification of all bony and dural defects that might be missed in preoperative images to ensure complete repair and prevent recurrence.

Glioblastoma multiforme in a patient with neurofibromatosis type 1: a case report and review of literature.

Glioblastoma multiforme (GBM) is a highly aggressive brain tumor. Individuals with neurofibromatosis type 1 (NF1) have an increased risk of developing GBM. We present a case report of a 44-year-old male with NF1 who developed GBM. NF1-associated GBM presents distinct molecular features and younger age at diagnosis compared to sporadic cases. Treatment typically follows standard protocols for GBM. Despite advancements in neuro-oncology, gaps in knowledge persist regarding NF1-associated GBM, including its prevalence, molecular mechanisms, and optimal treatment strategies. Larger studies and collaborative efforts are needed to address these gaps and enhance patient care.

Ultrahigh humidity-resistance ppb-level formaldehyde sensing at room temperature induced by fluorinated dipole based "umbrella" and "bridge".

Formaldehyde (HCHO) is a major indoor pollutant that is extremely harmful to human health even at ppb-level. Meanwhile, ppb-level HCHO is also a potential disease marker in the exhalation of patients with respiratory diseases. Higher humidity resistance and lower practical limit of detection (pLOD) both have to be pursued for practical HCHO sensors. In this work, by assembling indium oxide (In2O3) and fluorinated dipole modified reduced graphene oxide (rGO), we prepared a high-performance room temperature HCHO sensor (In2O3 @ATQ-rGO). Excellent sensing properties toward HCHO under visible illumination have been achieved, including ultra-low pLOD of 3 ppb and high humidity-resistance. By control experiments and density functional theory calculation, it is indicated that the introduced fluorinated dipoles act as not only an "umbrella" to improve the humidity resistance of the composite, but also a "bridge" to accelerate the electron transport, improving the sensitivity of the material. The significant practicality and reliability of the obtained sensors were verified by in-situ simulation experiments using a 3 m3 test chamber with a humidity control system and by detection of the simulated lung disease patient's exhalation. This work provides an effective strategy of simultaneously achieving high humidity-resistance and low pLOD of room temperature formaldehyde sensing materials.

Investigation of the phytochemical profiling and antioxidant, anti-diabetic, anti-inflammatory, and MDA-MB-231 cell line antiproliferative potentials of extracts from Ephedra alata Decne.

Ephedra is one of the many medicinal herbs that have been used as folk/traditional medicine in Jordan and other countries to cure various illnesses. Plants of this genus are well known for their antioxidant and antibacterial properties. In this study, three different solvents were used to obtain Ephedra extracts. When evaluated, the Ephedra alata Decne ethanolic extract reportedly had the greatest levels of total phenolic compounds (TPC) and total flavonoid compounds (TFC). The aqueous extracts displayed the highest antioxidant activity in the DPPH and ABTS assays, demonstrating their considerable capacity to neutralize free radicals. However, when evaluated using the FRAP method, the acetone extracts showed the strongest antioxidant activity, indicating their high reducing power. LC-MS/MS, a potent method of analysis that combines the liquid chromatographic separation properties with mass spectrometry detection and identification capabilities, was used in this study to detect and measure phytochemical content of a total of 24 phenolic compounds and 16 terpene compounds present in the extracts of Ephedra alata Decne. Various concentrations of these chemicals were found in these extracts. The extracts' inhibitory effects on albumin denaturation and alpha-amylase activity were also assessed; the findings demonstrated the potentials of these extracts as anti-inflammatory and anti-diabetic medicines, with the acetone extract having the lowest IC50 values in the concomitant tests (306.45 µg/ml and 851.23 µg/ml, respectively). Furthermore, the lowest IC50 value (of 364.59 ± 0.45 µg/ml) for the 80% ethanol extract demonstrated that it has the strongest antiproliferative impact regarding the MDA-MB-231 breast cancer cell line. This finding indicates that this particular extract can be potentially used to treat cancer.

The assessment of public perception towards chronic kidney disease in Jordan: a cross-sectional study.

OBJECTIVES: Kidney diseases are considered silent killers due to the lack of well-defined symptoms. Public knowledge about chronic kidney disease (CKD) management has been shown to decrease the risk of CKD onset and progression to end-stage renal disease and renal failure. The main objective of this study was to assess the knowledge of kidney function, CKD symptoms, etiology, prevention and treatment in the general population. METHODS: A cross-sectional study using a validated questionnaire was conducted in Jordan to assess public knowledge of CKD. Public knowledge of CKD was assessed using a questionnaire consisting of 32 knowledge questions, including risk factors, symptoms, treatment, protective measures and kidney function. The knowledge level was classified according to the total score: poor (0-50%), intermediate (51-70%) and good/high (71-100%). Multiple regression analysis was performed to compare knowledge scores (KS) and predict associations with the participants' baseline characteristics. RESULTS: The level of knowledge about CKD among the 2181 participants was intermediate. The KS was significantly higher among participants with health issues such as hypertension, diabetes and heart problems, first-degree relatives working in the medical field, majors relevant to health, married, employed, highly educated, high-income and smokers. The main sources of knowledge about CKD were health professionals, TV shows, books and magazines. Multiple regression analysis showed an association between KS and age, sex, functional status, educational level and field, income, smoking status, having a family member/spouse work in the medical field, and knowledge source. CONCLUSIONS: The public level of knowledge about CKD management is greatly influenced by participants' health and social factors. Thus, improving public knowledge and perception through education and the media will significantly reduce CKD prevalence and incidence.

Public awareness and educating the public about chronic kidney diseases (CKDs) is essential because of the high prevalence, and increased awareness can contribute to early detection, management and potentially slow down the progression of CKD.Creating awareness of the risk factors for CKD enables health policy developers to adopt preventive measures.CKD can significantly affect quality of life, and public awareness campaigns can emphasize the impact of CKD on overall well-being, motivating individuals to prioritize kidney health.

Phytochemical screening, antioxidant, anti-diabetic, and anti-obesity activities, formulation, and characterization of a self-nanoemulsion system loaded with pomegranate (Punica granatum) seed oil.

Pomegranate (Punica granatum) is a tree of the Punicaceae family that is widespread all over the world and has several types and therapeutic uses. The current study aimed to investigate the phytochemical compounds by GC analysis and carried out physical characterization of the pomegranate seed oil and its self-nanoemulsifying system. Then antioxidant, anti-diabetic, and anti-lipase activities were investigated for both.The pomegranate seed oil was extracted, and its self-nanoemulsifying system was then prepared. Phytochemical compounds were analyzed by GC, and physical characterization was established of the pomegranate seed oil and its self-nanoemulsifying system. Then antioxidant, anti-diabetic, and anti-lipase activities were investigated for both.The GC-MS analysis revealed that punicic acid, ß-eleosteric acid, catalpic acid, α-eleosteric acid, and oleic acid were the most predominant compounds in pomegranate seed oil. Other active compounds like linoleic acid, palmitic acid, stearic acid, and α-linolenic acid were detected in trace percentages. The self-nanoemulsifying system was prepared using various concentrations of surfactant (Tween 80), co-surfactant (Span 80), and pomegranate seed oil. The selected formulation had a PDI of 0.229 ± 0.09 and a droplet size of 189.44 ± 2.1 nm. The free radical scavenging activity of pomegranate seed oil, the self-emulsifying system, and Trolox was conducted using DPPH. The oil-self-nanoemulsifying system showed potent antioxidant activity compared to Trolox. Also, pomegranate oil inhibited α-amylase with a weak IC50 value of 354.81 ± 2.3 µg/ml. The oil self-nanoemulsifying system showed potent activity compared to acarbose and had a weaker IC50 value (616.59 ± 2.1 µg/ml) and a potent IC50 value (43.65 ± 1.9 µg/ml) compared to orlistat.Pomegranate seed oil self-nanoemulsifying system could be applied in the future for the preparation of possible oral medications for the prevention and treatment of oxidative stress, diabetes, and obesity due to its high activity against free radical, amylase, and lipase enzymes compared to pomegranate seed oil itself and the references used. This study reveals that self-nanoemulsion systems can enhance oil drug formulations by improving pharmacokinetics and pharmacodynamics, acting as drug reservoirs, and facilitating efficient oil release.

Metal Oxide Nanoparticles Exhibit Anti-Acanthamoeba castellanii Properties by Inducing Necrotic Cell Death.

PURPOSE: The treatment of amoebic infections is often problematic, largely due to delayed diagnosis, amoebae transformation into resistant cyst form, and lack of availability of effective chemotherapeutic agents. Herein, we determined anti-Acanthamoeba castellanii properties of three metal oxide nanoparticles (TiO2, ZrO2, and Al2O3). METHODS: Amoebicidal assays were performed to determine whether metal oxide nanoparticles inhibit amoebae viability. Encystation assays were performed to test whether metal oxide nanoparticles inhibit cyst formation. By measuring lactate dehydrogenase release, cytotoxicity assays were performed to determine human cell damage. Hoechst 33342/PI staining was performed to determine programmed cell death (apoptosis) and necrosis in A. castellanii. RESULTS: TiO2-NPs significantly inhibited amoebae viability as observed through amoebicidal assays, as well as inhibited their phenotypic transformation as evident using encystation assays, and showed limited human cell damage as observed by measuring lactate dehydrogenase assays. Furthermore, TiO2-NPs altered parasite membranes and resulted in necrotic cell death as determined using double staining cell death assays with Hoechst33342/Propidium iodide (PI) observed through chromatin condensation. These findings suggest that TiO2-NPs offers a potential viable avenue in the rationale development of therapeutic interventions against Acanthamoeba infections.

MicroRNA:Siglec crosstalk in cancer progression.

Aberrant Siglec expression in the tumour microenvironment has been implicated in tumour malignancies and can impact tumour behaviour and patient survival. Further to this, engagement with sialoglycans induces masked antigen recognition and promotes immune evasion, highlighting deregulated immune function. This necessitates the elucidation of their expression profiles in tumour progression. MicroRNAs (miRNAs) mediated targeting represents a novel approach to further elucidate Siglec potential and clinical relevance. Although miRNA activity in Siglec expression remains limited, we highlight current literature detailing miRNA:Siglec interactions within the tumour landscape and provide insights for possible diagnostic and therapeutic strategies in targeting the Siglec/sialic acid axis.

An efficient multi-level thresholding method for breast thermograms analysis based on an improved BWO algorithm.

Breast cancer is a prevalent disease and the second leading cause of death in women globally. Various imaging techniques, including mammography, ultrasonography, X-ray, and magnetic resonance, are employed for detection. Thermography shows significant promise for early breast disease detection, offering advantages such as being non-ionizing, non-invasive, cost-effective, and providing real-time results. Medical image segmentation is crucial in image analysis, and this study introduces a thermographic image segmentation algorithm using the improved Black Widow Optimization Algorithm (IBWOA). While the standard BWOA is effective for complex optimization problems, it has issues with stagnation and balancing exploration and exploitation. The proposed method enhances exploration with Levy flights and improves exploitation with quasi-opposition-based learning. Comparing IBWOA with other algorithms like Harris Hawks Optimization (HHO), Linear Success-History based Adaptive Differential Evolution (LSHADE), and the whale optimization algorithm (WOA), sine cosine algorithm (SCA), and black widow optimization (BWO) using otsu and Kapur's entropy method. Results show IBWOA delivers superior performance in both qualitative and quantitative analyses including visual inspection and metrics such as fitness value, threshold values, peak signal-to-noise ratio (PSNR), structural similarity index measure (SSIM), and feature similarity index (FSIM). Experimental results demonstrate the outperformance of the proposed IBWOA, validating its effectiveness and superiority.

Radiographic graft changes following maxillary sinus floor augmentation with autogenous bone compared with composite grafts: a one-year single-blind randomized controlled trial.

This study evaluated radiographic graft changes following maxillary sinus floor augmentation with (A) autogenous bone, (B) 1:1 autogenous bone and deproteinized porcine bone mineral, or (C) 1:1 autogenous bone and biphasic bone graft material. Sixty patients were randomly allocated to groups A, B, and C (20 in each). CBCT scans were obtained at enrolment, after surgery (T1), after prosthetic rehabilitation (T2), and 1 year after implant loading (T3). Significant decreases in graft volume (3D) and graft height (2D) from T1 to T3 were observed in all groups (P < 0.05). However, at T2 and T3, graft volume was significantly higher in group B than in groups A and C (P < 0.05), and graft height was significantly higher in group B than in group A (P < 0.05). Bone density increased significantly from T1 to T2 in all groups (P < 0.001). However, bone density was significantly higher in group B than in groups A and C, at T2 and T3 (P < 0.05). No significant correlation between graft volume or height and implant protrusion length or residual bone height was found. In conclusion, 1:1 autogenous bone and porcine bone resulted in significantly higher graft volume, height, and bone density when compared with autogenous bone or a 1:1 ratio of autogenous bone and biphasic bone. However the higher graft volume, height, and bone density did not appear to lead to improved outcomes at 1 year of functional loading when compared to the other groups.