Aging and sex are associated with multiple sleep latency test findings and their relationship with self-reported sleepiness.

The aim of this study was to assess age- and sex-related differences in multiple sleep latency test (MSLT) results and in the performance of the Epworth Sleepiness Scale (ESS) at classifying objective hypersomnia (mean sleep latency (MSL) ≤ 8 min). We studied 480 consecutive adults (39.3 ± 15.3 years old [18-93], 67.7% female) who underwent hypersomnia evaluation. We fit linear regression models to investigate associations between age and sex and sleep latencies (mean and for every nap), after adjusting for total sleep time and sleep efficiency (on polysomnography), and REM-suppressing antidepressant effect. A logistic regression was performed to assess whether age and sex were associated with sleep-onset REM period (SOREMP) occurrence. ROC analysis assessed the diagnostic performance of ESS scores to identify a MSL ≤ 8 min in different age/sex groups. For every 10 years of age, there was 0.41 (95% CI 0.11-0.72, p = 0.008) min reduction in MSL. Objectively (MSL ≤ 8 min) sleepy patients had shortening of latencies in naps 4 and 5 with aging. Female sex was associated with a higher MSL only in patients with MSL > 8 min. A 2.4% reduction in the odds of SOREMP occurrence was observed for every year of age in objectively sleepy patients (p = 0.045). ESS scores had a better diagnostic performance in older (≥ 50 years old) men than younger (< 50 years old) women (p < 0.05). Older patients with objectively confirmed hypersomnia may be sleepier in later naps, possibly due to less restorative naps and/or circadian rhythm factors. Self-reported sleepiness is more predictive of objective sleepiness in older men than younger women.

Correction: Aging and sex are associated with multiple sleep latency test findings and their relationship with self-reported sleepiness.

[This corrects the article DOI: 10.1007/s41105-024-00512-5.].

PyFaceWipe: a new defacing tool for almost any MRI contrast.

RATIONALE AND OBJECTIVES: Defacing research MRI brain scans is often a mandatory step. With current defacing software, there are issues with Windows compatibility and researcher doubt regarding the adequacy of preservation of brain voxels in non-T1w scans. To address this, we developed PyFaceWipe, a multiplatform software for multiple MRI contrasts, which was evaluated based on its anonymisation ability and effect on downstream processing. MATERIALS AND METHODS: Multiple MRI brain scan contrasts from the OASIS-3 dataset were defaced with PyFaceWipe and PyDeface and manually assessed for brain voxel preservation, remnant facial features and effect on automated face detection. Original and PyFaceWipe-defaced data from locally acquired T1w structural scans underwent volumetry with FastSurfer and brain atlas generation with ANTS. RESULTS: 214 MRI scans of several contrasts from OASIS-3 were successfully processed with both PyFaceWipe and PyDeface. PyFaceWipe maintained complete brain voxel preservation in all tested contrasts except ASL (45%) and DWI (90%), and PyDeface in all tested contrasts except ASL (95%), BOLD (25%), DWI (40%) and T2* (25%). Manual review of PyFaceWipe showed no failures of facial feature removal. Pinna removal was less successful (6% of T1 scans showed residual complete pinna). PyDeface achieved 5.1% failure rate. Automated detection found no faces in PyFaceWipe-defaced scans, 19 faces in PyDeface scans compared with 78 from the 224 original scans. Brain atlas generation showed no significant difference between atlases created from original and defaced data in both young adulthood and late elderly cohorts. Structural volumetry dice scores were ≥ 0.98 for all structures except for grey matter which had 0.93. PyFaceWipe output was identical across the tested operating systems. CONCLUSION: PyFaceWipe is a promising multiplatform defacing tool, demonstrating excellent brain voxel preservation and competitive defacing in multiple MRI contrasts, performing favourably against PyDeface. ASL, BOLD, DWI and T2* scans did not produce recognisable 3D renders and hence should not require defacing. Structural volumetry dice scores (≥ 0.98) were higher than previously published FreeSurfer results, except for grey matter which were comparable. The effect is measurable and care should be exercised during studies. ANTS atlas creation showed no significant effect from PyFaceWipe defacing.

Validation and identification of promising gene specific markers governing foliar disease resistance in groundnut (Arachis hypogaea L.).

BACKGROUND: Groundnut is vulnerable to the major foliar fungal disease viz., late leaf spot (LLS) and rust in kharif season, which results in severe yield losses. Until now, LLS and rust resistance linked markers were developed based on GPBD 4 as a major donor source and were validated in its derivatives only, which restricted their use in marker assisted selection (MAS) involving other donors. METHODS AND RESULTS: The current study focused to validate LLS and rust resistance linked markers employing advanced breeding lines of F6 generation, derived from nine different crosses involving nine diverse parents, to identify potential markers for marker-assisted breeding of LLS and rust resistance in groundnut. Out of 28-trait linked markers used for validation, 8 were polymorphic (28.57%). Marker-trait association (MTA) and Single Marker Analysis (SMA) revealed that the SSR marker pPGPseq5D05 is significantly associated with both LLS (15.8% PVE) and rust (17.5% PVE) resistance, whereas, the marker IPAHM103 is tightly linked with rust resistance (26.8% PVE) alone. In silico analysis revealed that the marker gene for IPAHM103 is a zinc finger protein and the marker gene for pPGPseq5D05 is an ADP-ribosylation factor GTPase-activating protein. Both these protein products impart resistance or tolerance to biotic stress in crop plants. Two other markers namely, GMLQ975 and pPGPseq13A10 were also found to be associated with LLS resistance explaining MTA up to 60%. CONCLUSION: These gene specific markers will enable us to screen more number of germplasm lines or newly developed lines in MAS schemes for LLS and rust resistance using a wide range of resistant sources.

Sustainable seedling pots: Development and characterisation of banana waste and natural fibre-reinforced composites for horticultural applications.

Plastic pots used in horticultural nurseries generate substantial waste, causing environmental pollution. This study aimed to develop biodegradable composites from banana pseudo-stem reinforced with agricultural residues like pineapple leaves, taro and water hyacinth as eco-friendly substitutes. The aim of this study is to develop optimised banana biocomposite formulations with suitable reinforcements that balance mechanical durability, biodegradation, and seedling growth promotion properties to serve as viable eco-friendly alternatives to plastic seedling pots. This study was carried out by fabricating banana fibre mats through pulping, drying and hot pressing. Composite sheets were reinforced with 50 % pineapple, taro or water hyacinth fibres. The mechanical properties (tensile, yield strength, elongation, bursting strength), hydrophilicity (contact angle, water absorption), biodegradability (soil burial test), and seedling growth promotion were evaluated through appropriate testing methods. The results show that banana-taro composites exhibited suitable tensile strength (25 MPa), elongation (27 %), water uptake (41 %) and 82 % biodegradation in 60 days. It was observed that biodegradable seedling trays fabricated from banana-taro composite showed 95 % tomato seed germination and a 125 cm plant height increase in 30 days, superior to plastic trays. The finding shows that the study demonstrates the potential of banana-taro biocomposites as alternatives to plastic nursery pots, enabling healthy seedling growth while eliminating plastic waste pollution through biodegradation.

Effect of pulsed electric field processing on the quality characteristics and enzyme activity of tender coconut water.

Tender coconut water (TCW) is a natural drink rich in natural electrolytes, minerals, salts and sugars; it has good health benefits. But, its shelf-life is very limited because of the active nature of enzymes present in it when exposed to air. Therefore, the processing of TCW is necessary to inactivate the enzymes. So, this study aims to observe the effect of various process parameters of pulsed electric field (PEF) on the quality parameters of TCW. For the treatment of TCW with PEF, a full-factorial design of experiments was followed with process parameters such as three levels of electric field intensity (8, 12, and 16 kV/cm), two levels of pulse width (PW) (50 and 70 µs), and six levels of the number of pulses (2000 to 12,000 pulses) were considered at a constant pulse OFF time of 75 ms. PEF treatment did not significantly change pH, total soluble solids, and viscosity. However, it significantly affected vitamin C, colour, and total and reducing sugars. PEF treatment significantly enhanced the total phenolic content and antioxidant activity by 23.17% and 42.49%, respectively. At the same time, significant inactivation of polyphenol oxidase (100%) and peroxidase (60.2%) was observed at PEF treatment conditions of 16 kV/cm, 70 µs PW, and 12,000 pulses. Moreover, no significant change in the sensory acceptability of PEF-treated TCW (16 kV/cm, 70 µs PW, 12,000 pulses) when compared to the untreated/fresh TCW, which is a promising sign.

PROTEIN L-ISOASPARTYL METHYLTRANSFERASE protects enolase dysfunction by repairing isoaspartyl-induced damage and is positively implicated in agronomically important seed traits.

The protein-repairing enzyme (PRE) PROTEIN L-ISOASPARTYL METHYLTRANSFERASE (PIMT) influences seed vigor by repairing isoaspartyl-mediated protein damage in seeds. However, PIMTs function in other seed traits, and the mechanisms by which PIMT affects such seed traits are still poorly understood. Herein, through molecular, biochemical, and genetic studies using overexpression and RNAi lines in Oryza sativa and Arabidopsis thaliana, we demonstrate that PIMT not only affects seed vigor but also affects seed size and weight by modulating enolase (ENO) activity. We have identified ENO2, a glycolytic enzyme, as a PIMT interacting protein through Y2H cDNA library screening, and this interaction was further validated by BiFC and co-immunoprecipitation assay. We show that mutation or suppression of ENO2 expression results in reduced seed vigor, seed size, and weight. We also proved that ENO2 undergoes isoAsp modification that affects its activity in both in vivo and in vitro conditions. Further, using MS/MS analyses, amino acid residues that undergo isoAsp modification in ENO2 were identified. We also demonstrate that PIMT repairs such isoAsp modification in ENO2 protein, protecting its vital cellular functions during seed maturation and storage, and plays a vital role in regulating seed size, weight, and seed vigor. Taken together, our study identified ENO2 as a novel substrate of PIMT, and both ENO2 and PIMT in turn implicate in agronomically important seed traits.

Ameliorative effect of ferulic acid on thyroid dysfunction against propyl-thiouracil induced hypothyroid rats.

PURPOSE: Hypothyroidism is an endocrine disorder characterised by decreased T3, T4 and increased TSH levels. This study aims to examine the potential effects of Ferulic acid (FA) on rats with hypothyroidism induced by propylthiouracil through the estimation of biochemical parameters and histopathological studies. METHODS: Twenty-five female wistar rats were allocated into five groups: Control group [1% CMC, p.o.], Disease group [PTU-50 mg/kg, p.o.], [Levothyroxine (LT4) group - 20 µg/kg, p.o. + PTU-50 mg/kg, p.o.], [FA -25 mg/kg, p.o. + PTU-50 mg/kg, p.o.] and [FA 50 mg/kg, p.o. + PTU-50 mg/kg, p.o.]. On 15th day blood was collected and serum was separated for estimation of biochemical parameters, liver and kidney homogenate was utilised for the estimation of oxidative stress markers and the thyroid gland was dissected to examine histological features. RESULTS: PTU administration for 14 days showed a substantial decline in T3 and T4 and increases in TSH levels. PTU-administered rats significantly increased TC, TG and LDL levels, and decreased HDL levels. AST, ALT, urea, creatinine, and IL-6 were determined and these levels were significantly altered in PTU-induced hypothyroid group. In hypothyroid rats MDA, NO, GSH and SOD levels were significantly altered. However, treatment with FA for 14 days attenuated PTU-induced alterations. Furthermore, FA improves the histological changes of the thyroid gland. CONCLUSION: In conclusion, FA treatment showed a protective effect against hypothyroidism by stimulating the thyroid hormones through the activation of thyroid peroxidase enzyme and improving thyroid function. In addition, FA diminished the increase in lipids, liver and kidney markers, oxidative stress and inflammation.

A comparative assessment of biomethane potential of fresh fecal matter and fecal sludge and its correlation with malodor.

Comprehensive and proper management of fecal sludge (FS) is an ongoing concern in many nations. Decentralized fecal sludge treatment plants (FSTPs) are effective in this regard; however, many have experienced strong public opposition based partly on suspicion of malodor. Fecal sludge and freshly generated fecal matter (FM) samples from various FSTPs were collected, characterized, and investigated for biomethane potential. The homogenized samples were anaerobically digested for 28 days. Digestion successfully reduced total suspended solids, biochemical oxygen demand, and threshold odor number values of 97,350-97,420 mg/l, 43,230-43,260 mg/l, and 130-150 for FM, to 49,500-49,650 mg/l, 23,760-23,850 mg/l, and 3338, respectively, for FS samples. The comprehensive gas yield from Bhongir, Boduppal, and Shadnagar FS samples was 40, 55, and 31 ml, respectively. In contrast, cumulative gas generation from the FM was 26,361 ml. Digestion of FS samples also reduced concentrations of volatile solids and coliforms by 66-72% and 99%, respectively. Characterization of gas samples revealed methane and carbon dioxide concentrations as 56% and 22% for FM, and 0.4% and 61% for FS samples, respectively. Hydrogen sulfide and ammonia gas were absent in FS samples, dispelling common societal misconceptions of FSTPs being associated with malodor.

Recent advances in protein-polysaccharide based biocomposites and their potential applications in food packaging: A review.

This review addresses the current trend of replacing petroleum-based polymers in food packaging with bio-based alternatives, specifically focusing on proteins and polysaccharides. While these biopolymers exhibit excellent film-forming properties and are abundant in nature, their individual use in packaging lacks ideal plastic-like characteristics, especially in terms of mechanical and barrier properties. A recent solution involves the formulation of biocomposites through the reinforcement of one biopolymer with another (e.g., protein with a polysaccharide), significantly enhancing the physical, mechanical, and barrier properties of packaging materials. The review concentrates on the integration of proteins and polysaccharides in biocomposite materials, emphasizing their potential applications in active and intelligent food packaging systems. It covers sources, manufacturing methods, interaction mechanisms, recent developments, perspectives, and opportunities. The exploration extends to practical implementations of these biocomposites in enhancing food quality, safety, and shelf life-a green technological approach contributing to the reduction of food waste and loss.

Neglected Tropical Diseases: A Comprehensive Review.

Neglected tropical diseases (NTDs) are a group of diseases caused by diverse organisms, affecting millions of people in tropical and subtropical conditions. NTDs are more prevalent among people who live in poverty, without access to clean water, adequate sanitation, and quality health care. Most NTDs are chronic conditions and are potentially disablers than killers, leaving behind a trail of social consequences. Controlling NTDs has become complicated due to limited resources and are frequently ignored by global funding agencies. India experiences a significant burden of global NTDs. The paradox is that NTDs are preventable and treatable at an affordable cost. It then makes no sense as to why we co-exist with such diseases. The World Health Organization (WHO) has donned the leadership role of eliminating, eradicating, and controlling global NTDs. The WHO published a roadmap delineating a plan of action, which was being reviewed periodically. This led to substantive progress in tackling the NTDs. However, many challenges still exist to controlling and preventing NTDs. India has achieved significant progress towards NTD control and elimination by implementing the WHO strategies and action plans. This was evident by an increase in research and funding in this direction. The number of new drugs, vaccines, and investigative tools available and those in the pipeline is testimony to their efforts. Focusing singly on India's NTD problem would substantially reduce the burden of poverty-related neglected diseases and could dramatically advance the global health agenda. This review highlights the problem of NTDs in the Indian and global perspective.

Correlates to Improvement in Sleep Duration in Acute Mania and Depression.

Objective: To examine sleep duration at admission and discharge and change in sleep duration during hospitalization in patients experiencing a manic episode and compare these parameters to patients hospitalized for major depressive disorder (MDD) during the same time frame. The correlation between sleep duration parameters in those with mania and MDD with length of hospital stay, after accounting for possible confounders, was also examined.Methods: This retrospective study examined patients admitted to an acute care psychiatric unit from 2018 to 2021 with an episode of mania or MDD. Sleep duration was determined based on nursing observer report.Results: The study included 41 patients with mania (32.9 ± 1.7 years) and 38 patients with MDD (32.7 ± 1.8 years). Mania patients had longer hospitalization and received higher antipsychotic and benzodiazepine doses, but fewer hypnotics (all P < .005). No differences were found in sleep duration at admission (P = .109) and discharge (P = .623) in the mania and MDD groups. Change in sleep duration was 1.14 ± 0.27 and 0.37 ± 0.28 hours (P = .05) in the groups, respectively. In those with mania, sleep duration at admission negatively correlated with length of stay (r = -0.033; P = .03). Sleep duration parameters were not correlated with length of stay in patients with MDD.Conclusion: There was a trend toward greater improvement in sleep duration in inpatients with mania versus MDD. Sleep duration at admission correlated with length of hospitalization in patients with mania. Future studies should examine whether attempts to increase sleep duration can improve patient outcomes.Prim Care Companion CNS Disord 2024;26(1):23m03620. Author affiliations are listed at the end of this article.

Prevalence and associations of multiple hypnotic prescriptions in a clinical sample.

STUDY OBJECTIVES: We examined the prevalence of multiple hypnotic prescriptions and its association with clinical and demographic characteristics from the electronic health record (EHR) in the Mayo Clinic Biobank. METHODS: Adult participants enrolled in the Mayo Clinic Biobank with an EHR number of ≥ 1 year were included (n = 52,940). Clinical and demographic characteristics were compared between participants who were and were not prescribed any hypnotic approved for insomnia by the US Food and Drug Administration and/or trazodone and in those prescribed a single vs multiple (≥ 2) hypnotics. A phenotype-based, phenome-wide association study (PheWAS) examining associations between hypnotic prescriptions and diagnoses across the EHR was performed adjusting for demographic and other confounders. RESULTS: A total of 17,662 (33%) participants were prescribed at least 1 hypnotic and 5,331 (10%) received ≥ 2 hypnotics. Participants who were prescribed a hypnotic were more likely to be older, female, White, with a longer EHR, and a greater number of diagnostic codes (all P < .001). Those with multiple hypnotic prescriptions were more likely to be younger, female, with a longer EHR, and a greater number of diagnostic codes (all P < .001) compared with those prescribed a single hypnotic. The PheWAS revealed that participants with multiple hypnotic prescriptions had higher rates of mood disorders, anxiety disorders, suicidal ideation, restless legs syndrome, and chronic pain (all P < 1 e-10). CONCLUSIONS: Receiving multiple hypnotic prescriptions is common and associated with a greater prevalence of psychiatric, chronic pain, and sleep-related movement disorders. Future studies should examine potential genetic associations with multiple hypnotic prescriptions to personalize treatments for chronic insomnia. CITATION: Kolla BP, Mansukhani MP, Chakravorty S, Frank JA, Coombes BJ. Prevalence and associations of multiple hypnotic prescriptions in a clinical sample. J Clin Sleep Med. 2024;20(5):793-800.

Thermoalkalophilic polygalacturonase from a novel Glutamicibacter sp.: Bioprospecting, strain improvement, statistical optimization and applications.

The current research discusses a multidimensional bioprocess development, that includes bioprospecting, strain improvement, media optimisation, and applications of the extracted enzyme. A potent alkalophilic polygalacturonase (PG) producing bacterial strain was isolated and identified as a novel Glutamicibacter sp. Furthermore, strain improvement by UV and chemical mutagenesis not only improved the enzyme (PGmut) production but also enhanced its temperature optima from 37 °C to 50 °C. The use of solid substrate fermentation, followed bystatistical optimisation through PB and RSM, substantially increasedPGmut production. A 10-fold increase in enzyme production (632 U/gm) was observed when sugarcane bagasse with a pH of 10.5, 66.8 % moisture, and an inoculum size of 10.15 % was used. The model's accuracy was supported by p-value (p < 0.0001), and an R2 of 0.9940. A pilot-scale experiment, demonstrated ≈ 62,229 U/100 gm PG activity. Additionally, the enzyme's efficacy in demucilization of coffee beans, and bioscouring of jute fibre indicated that it is a valuable biocatalyst.

Clinical Utility and Impact of Phosphatidylethanol Testing in Liver Transplantation Evaluations.

BACKGROUND: Phosphatidylethanol (PEth) is a serum biomarker that can detect alcohol use within the last 28 days with excellent sensitivity and specificity. Urinary ethyl glucuronide (uEtG) is commonly used in transplant settings to screen for alcohol use; however, it has several limitations relevant to liver transplantation. Transplant centers are beginning to regularly utilize PEth as part of the screening process for high-risk liver transplantation candidates although the clinical utility of uniform pre-transplant PEth testing is unclear. METHODS: This was a retrospective chart review of all patients evaluated for liver transplantation from December 1, 2019, through May 31, 2022, at a large academic tertiary referral center utilizing uniform serum PEth and uEtG screening. Information regarding the patients' transplantation status, age, sex, race, Model for End-Stage Liver Disease score, and PEth levels was obtained. In those with a positive PEth, we examined if the result would have been detected with uEtG, identified a discrepancy from the documented patient report of last use, led to a change in the Psychosocial Assessment of Candidate for Transplantation score, or influenced the transplant selection committee's decision. RESULTS: Our sample included 865 individuals (mean age = 55.20, 61.27% male and 82.54% white) with calculated Model for End-Stage Liver Disease-Sodium scores ranging from 6.43 to 50.65 (mean: 18.09; median: 16.46). Forty-eight patients were found to have a positive PEth (PEth range 20-1833); 75% of the sample had alcohol-associated liver disease. In 23 of 48 (47.91%) cases, the positive PEth identified alcohol use missed by a concomitant uEtG screen. A positive PEth test identified a discrepancy from patients' self-report in 29 (60.42%) cases and influenced the selection committee's decision in 28 cases (58.33%). CONCLUSION: Uniform pretransplant PEth screening of liver transplant candidates at the time of initial evaluation identified alcohol use that would have been missed by uEtG testing, identified discrepancies from the patient's self-report, and influenced clinical decision-making in a significant number of cases. These findings support the use of uniform PEth screening in liver transplantation evaluations.

Self-powered, wide spectral UV response out-of-plane photodetector based on ZnO/porous silicon heterostructure.

The photoresponse of the ZnO/porous silicon (p-Si) heterojunction is studied in an out-of-plane contact configuration. p-Si substrate is fabricated by anodic etching followed by the electrochemical deposition of ZnO NR film, forming ZnO/p-Si heterojunction. XRD study is done to understand the effect of the substrate on ZnO film growth in terms of strain and crystal size. UV-vis absorbance spectrum shows a broad absorption for wavelengths from 230 to 380 nm. The PL emission shows two narrow and prominent electron transition peaks at 263 and 383 nm and a peak of ∼550 nm corresponding to defects. The 263 nm wavelength responsivity of the photodetector from UV-vis and PL data suggests the presence of a defective SiOxas an intermediate layer between ZnO and p-Si. The photodetector is measured for its spectral selectivity and responsivity for both 266 and 370 nm. Under self-powered conditions, the device shows a low dark current of a few nA and enhancement of ∼100 nA and ∼1.37µA for both wavelengths. A responsivity of 527 mA W-1and 10.5µA W-1and detectivity of 2.5 × 1010and 2.9 × 107Jones at 1 V bias under 266 and 370 nm UV illumination are observed. The fast rise/decay time of 67/65 ms and 29/18 ms is observed for the self-powered condition of the device under both wavelengths respectively. The photoresponse of the modified ZnO/SiOx/p-Si heterojunction for both wavelengths is analyzed for the electron transfer mechanism using the heterojunction band bending model. The short circuit current and open circuit voltage of the photodetector is estimated to be 293 nA, 56.33 mV, and 13.63µA, 124.8 mV for 266 and 370 nm, respectively. It is concluded that the 266 nm responsivity comes from the defects in SiOxintermediate layer, and the photocurrent generated in the device is due to tunneling across the junction.

3D Printed Lattice Template by Material Extrusion Technique for Fabrication of Pixelated Photodetector.

Rigid and flexible, pixelated ultraviolet photodetectors (PD) based on ZnO have been fabricated by material extrusion 3D printing technique. The photoresponse is studied in an out-of-plane configuration. An open lattice structure is printed using PLA over ITO/Glass substrate for rigid, and TPU over ITO/PET substrate for flexible PDs. ZnO slurry is filled selectively into the columnar matrix by the microdispensing technique. The optical detector printed on ITO/Glass substrate shows a sensitivity of 25 and responsivity of 1.55 nA/mW with a rise and decay time of 1.6 and 0.6 s, respectively. Similarly, the flexible PD printed using TPU lattice shows a sensitivity of 9.5 and responsivity of 0.38 nA/mW with a rise and decay time of 1.8 and 0.6 s, respectively. The charge transport mechanism is studied using band diagram analysis. 3D printed open lattice structure is found to be a potential template for sensor fabrication. This work demonstrates the capability of material extrusion 3D printing with an open lattice structure for the fabrication of high-resolution pixelated PDs.

Harnessing artificial intelligence in radiology to augment population health.

This review article serves to highlight radiological services as a major cost driver for the healthcare sector, and the potential improvements in productivity and cost savings that can be generated by incorporating artificial intelligence (AI) into the radiology workflow, referencing Singapore healthcare as an example. More specifically, we will discuss the opportunities for AI in lowering healthcare costs and supporting transformational shifts in our care model in the following domains: predictive analytics for optimising throughput and appropriate referrals, computer vision for image enhancement (to increase scanner efficiency and decrease radiation exposure) and pattern recognition (to aid human interpretation and worklist prioritisation), natural language processing and large language models for optimising reports and text data-mining. In the context of preventive health, we will discuss how AI can support population level screening for major disease burdens through opportunistic screening and democratise expertise to increase access to radiological services in primary and community care.

The Impact and Prognostic Significance of Extra-Nodal Extension in Clinically N0 Oral Cancer: A Prospective Clinical Study.

Oral cavity squamous cell carcinoma (OCSCC) demonstrates a high propensity to metastasize to regional lymph nodes. Despite technological and scientific advances, identification of pathological adverse features preoperatively remains elusive. This study intended to identify the true occurrence of extra-nodal extension (ENE) in clinically and radiologically N0 OCSCC patients and to investigate its impact and prognostic significance. A prospective, single-centre, non-randomized study was conducted at a tertiary cancer centre in South India to include all untreated operable patients of OCSCC without clinical, radiological, or cytological evidence of nodal metastasis (cN0). All the patients underwent tumor resection surgery with neck dissection and received adjuvant therapy when indicated. Patients were followed up and neck dissection specimens were histopathologically analyzed. The primary outcome was to assess the presence of ENE in cN0 OCSCC patients and its extent. The secondary outcomes were 2-year disease-free survival (DFS) and tumor characteristics. A total of 237 patients with operable OCSCC were evaluated. Out of these, 80 patients who were clinically and radiologically N0 were included in the study and they underwent tumor resection surgery and neck dissection. The final histopathological evaluation revealed that 21.25% of patients (n = 17) had metastatic neck disease and 7.5% of patients (n = 6) had ENE, and all were reported as microscopic ENE. Within the node-positive group, the 2-year DFS for patients with and without ENE were 50% and 90.9%, respectively (p = 0.0362). The results suggest that ENE remains a strong predictor of adverse outcomes, recurrence, and survival in oral cancer patients.