The discerning influence of dynamic contrast-enhanced MRI in anticipating molecular subtypes of breast cancer through the artistry of artificial intelligence - a narrative review.

Radio genomics is an exciting new area that uses diagnostic imaging to discover genetic features of diseases. In this review, we carefully examined existing literature to evaluate the role of artificial intelligence (AI) and machine learning (ML) on dynamic contrastenhanced MRI (DCE-MRI) data to distinguish molecular subtypes of breast cancer (BC). Implications to noninvasive assessment of molecular subtype include reduction in procedure risks, tailored treatment approaches, ability to examine entire lesion, follow-up of tumour biology in response to treatment and evaluation of treatment resistance and failure secondary to tumour heterogeneity. Recent studies leverage radiomics and AI on DCE-MRI data for reliable, non-invasive breast cancer subtype classification. This review recognizes the potential of AI to predict the molecular subtypes of breast cancer non-invasively.

An intelligent diabetes classification and perception framework based on ensemble and deep learning method.

Sugar in the blood can harm individuals and their vital organs, potentially leading to blindness, renal illness, as well as kidney and heart diseases. Globally, diabetic patients face an average annual mortality rate of 38%. This study employs Chi-square, mutual information, and sequential feature selection (SFS) to choose features for training multiple classifiers. These classifiers include an artificial neural network (ANN), a random forest (RF), a gradient boosting (GB) algorithm, Tab-Net, and a support vector machine (SVM). The goal is to predict the onset of diabetes at an earlier age. The classifier, developed based on the selected features, aims to enable early diagnosis of diabetes. The PIMA and early-risk diabetes datasets serve as test subjects for the developed system. The feature selection technique is then applied to focus on the most important and relevant features for model training. The experiment findings conclude that the ANN exhibited a spectacular performance in terms of accuracy on the PIMA dataset, achieving a remarkable accuracy rate of 99.35%. The second experiment, conducted on the early diabetes risk dataset using selected features, revealed that RF achieved an accuracy of 99.36%. Based on our experimental results, it can be concluded that our suggested method significantly outperformed baseline machine learning algorithms already employed for diabetes prediction on both datasets.

Natural compounds for oxidative stress and neuroprotection in schizophrenia: composition, mechanisms, and therapeutic potential.

OBJECTIVE: An imbalance between the generation of reactive oxygen species (ROS) and the body's antioxidant defense mechanisms is believed to be a critical factor in the development of schizophrenia (SCZ) like neurological illnesses. Understanding the roles of ROS in the development of SCZ and the potential activity of natural antioxidants against SCZ could lead to more effective therapeutic options for the prevention and treatment of the illness. METHODS: SCZ is a mental disorder characterised by progressive impairments in working memory, attention, and executive functioning. In present investigation, we summarized the experimental findings for understanding the role of oxidative stress (OS) in the development of SCZ and the potential neuroprotective effects of natural antioxidants in the treatment of SCZ. RESULTS: Current study supports the use of the mentioned antioxidant natural compounds as a potential therapeutic candidates for the treatment of OS mediated neurodegeneration in SCZ. DISCUSSION: Elevated levels of harmful ROS and reduced antioxidant defense mechanisms are indicative of increased oxidative stress (OS), which is associated with SCZ. Previous research has shown that individuals with SCZ, including non-medicated, medicated, first-episode, and chronic patients, exhibit decreased levels of total antioxidants and GSH. Additionally, they have reduced antioxidant enzyme levels such as catalase (CAT), glutathione (GPx), and, superoxide dismutase (SOD) and lower serum levels of brain-derived neurotrophic factor (BDNF) in their brain tissue. The mentioned natural antioxidants may assist in reducing oxidative damage in individuals with SCZ and increasing BDNF expression in the brain, potentially improving cognitive function and learning ability.

Unveiling a Unique Case of Scimitar Syndrome: Clinical Significance and Multidisciplinary Management Challenges in Pakistan.

Scimitar syndrome, a rare congenital cardiac anomaly, involves abnormal pulmonary vein drainage into systemic veins, leading to distinct imaging features resembling a curved-blade sword. This case report presents a unique instance of scimitar syndrome in Pakistan, emphasizing its clinical importance and the challenges of management. A 26-year-old female with a history of recurrent pulmonary infections and respiratory symptoms since childhood was diagnosed with scimitar syndrome. Radiological assessments, including chest X-rays, computed tomography pulmonary angiograms (CTPA), and transthoracic echocardiography, confirmed the presence of a curved vessel originating from the right hemidiaphragm and connecting with the inferior vena cava (IVC). The patient and her medical team opted for conservative management, involving multidisciplinary care, tailored treatment for infections, and regular monitoring. The rarity of Scimitar syndrome necessitates careful diagnosis and management decisions. While surgical intervention is often recommended, this case demonstrates the complexities of choosing conservative management based on patient preferences and the evolving clinical course. A literature review reveals varied outcomes of surgical and conservative approaches, emphasizing the need for personalized strategies. Radiological techniques, such as CTPA and MRI, play pivotal roles in diagnosis and monitoring. This case report underscores the clinical significance of scimitar syndrome, particularly in regions with limited reported cases, like Pakistan. The multidisciplinary management approach, the decision-making process regarding conservative treatment, and the unique radiological findings contribute to the medical community's understanding of this rare condition.

'Bubbles and esophagus: A tale of unexpected and otherwise unexplained pain'.

Boerhaave's syndrome is a potentially fatal emergency, typically induced by forceful retching, which leads to increased intra-esophageal pressure. It commonly presents with vague symptoms such as chest pain or more classic symptoms like subcutaneous emphysema and vomiting. We present an unusual case of Boerhaave syndrome secondary to rapid and excessive intake of carbonated drinks in a 22-year-old male, who presented to our emergency department with atypical symptoms of fever and shortness of breath. Imaging studies showed left-sided hydropneumothorax with an esophageal pleural fistula, and multidisciplinary teams were involved in the patient's management.

Effect of lignocellulosic corn stalk on mechanical, physical, and thermal properties of injection moulded low density polyethylene composites: An approach towards a circular economy.

Escalating concern over global warming, which is mostly associated with deforestation, has led to the development of new classes of materials that can replace wood and better utilise natural resources. Presently, waste is a significant factor in recycling. In this regard, one of the leading contributors to waste is agricultural waste, which includes dried branches, leaves of trees, plants, and other organic materials. In the current study, waste from corn agriculture was utilised as a potential reinforcement for the fabrication of corn stalk-low density polyethylene (CS-LDPE) composites via an injection moulding technique at 170 °C. The different parameters were assessed to develop composites using CS, including physico-chemical, macromolecular, mineralogical, elemental, and morphological analysis. The amount of corn stalk (CS) was varied from 10 to 50 wt% with respect to the polymer. The mechanical, physical and thermal performance of the composites was examined. The density and water absorption of the composites were found to remain within the ranges of 1.00-1.11 g/cm3 and 0.22-1.01 %, respectively, whereas these parameters increased as the proportion of CS increased. The thermal conductivity decreases with the addition of CS from 0.36964 ± 0.020 to 0.22388 ± 0.002 W/mK. It was observed that adding CS to the composites increased their tensile and flexural properties, but decreased their impact strength. The maximum flexural strength of 14.40 ± 1.558 MPa, flexural modulus of 752.53 ± 180.409 MPa, tensile strength of 10.49 ± 0.946 MPa and tensile modulus of 539.79 ± 91.044 MPa were observed with a 50 % CS content. The results suggest that these materials have considerable potential to serve as a cost-effective substitute for the conventional lignocellulosic fillers in the manufacturing of wood-plastic composites.

Fetal choroid plexus arteriovenous malformation, masquerading as a neoplastic lesion.

A woman in her 20s, who was pregnant, underwent a routine antenatal ultrasound revealing organised intraventricular haemorrhage and a vascular area in the left thalamic region. Fetal MRI raised suspicion of arteriovenous malformation (AVM). The baby was delivered at 36 weeks via C-section, and initial brain MRI suggested a possible neoplastic lesion.Cerebral angiography confirmed a large AVM involving the left choroid plexus with arterial feeders from the left anterior and posterior choroidal arteries and a large venous varix draining into the vein of Galen. Both arterial feeders were successfully embolised with Onyx and glue, achieving complete occlusion.Choroid plexus AVMs are rare and often lead to intraventricular or intraparenchymal haemorrhage. Surgical treatment has shown success, but endovascular management is effective, especially for small, deep-seated AVMs, offering a better prognosis.

Development and Validation of Apeiroanxiety Scale in the Context of the Afterlife for Pakistani Muslim Adults.

Apeiroanxiety is a fear of infinity. Some people may experience anxiety or discomfort when contemplating the vastness or endless nature of certain concepts, such as time or space. Addressing any form of anxiety is important as it can impact an individual's daily functioning, wellbeing, and quality of life. The current study is aimed at developing a reliable and valid measure of apeiroanxiety in the context of the afterlife for the Pakistani Muslim population. The research had three studies: Query Study I generated an item pool of 18 items based on a literature review, semi-structured interviews, and expert opinion. This item pool was administered to a convenient sample of Pakistani Muslim participants (n = 1277). As a result of exploratory factor analysis, a uni-dimensional factor solution with five items was yielded (α = 0.90). Confirmatory factor analysis confirmed the obtained uni-dimensional factor solution in study II of the research with an excellent model fit. In study III, the convergent and discriminant validity of the scale was established on a separate independent sample (n = 485). Results yielded evidence of convergent validity as negative afterlife belief and rumination had a positive correlation with apeiroanxiety. The discriminant validity was established by a non-significant relationship between positive afterlife belief and apeiroanxiety. Moreover, the limitations, suggestions, and implications of the study are discussed.

Location Matters: The Role of the Neighborhood Environment for Incident Cardiometabolic Disease in Adults Aging With Physical Disability.

PURPOSE: People aging with disability may be limited in their ability to engage in healthy behaviors to maintain cardiometabolic health. We investigated the role of health promoting features in the neighborhood environment for incident cardiometabolic disease in adults aging with physical disability in the United States. DESIGN: Retrospective cohort study. SETTING: Optum's Clinformatics® Data Mart Database (2007-2018) of administrative health claims. SUBJECTS: ICD-9-CM codes were used to identify 15 467 individuals with a diagnosis of Cerebral Palsy, Spina Bifida, Multiple Sclerosis, or Spinal Cord Injury. MEASURES: Cardiometabolic disease was identified using ICD-9-CM/ICD-10-CM codes over 3 years of follow-up. Measures of the neighborhood environment came from the National Neighborhood Data Archive and linked to individual residential ZIP codes over time. Covariates included age, sex, and comorbid health conditions. ANALYSIS: Cox regression models estimated hazard ratios (HR) for incident cardiometabolic disease. Using a 1-year lookback period, individuals with pre-existing cardiometabolic disease were excluded from the analysis. RESULTS: Net of individual risk factors, residing in neighborhoods with a greater density of broadband Internet connections (HR = .88, 95% CI: .81, .97), public transit stops (HR = .89, 95% CI: .83, .95), recreational establishments (HR = .89, 95% CI: .83, .96), and parks (HR = .88, 95% CI: .82, .94), was associated with reduced risk of 3-year incident cardiometabolic disease. CONCLUSION: Findings identify health-promoting resources that may mitigate health disparities in adults aging with disability.

Development and validation of Unsuccessful Disengagement Aging Scale (UDAS) for older adults.

The present study aimed to develop a precise and reliable measure of unsuccessful disengagement among older adults, defined as involuntary withdrawal from societal roles and norms due to familial or societal pressure, resulting in the transfer of responsibilities to the younger generation. High scores on the Unsuccessful Disengagement Aging Scale (UDAS) were indicative of a greater degree of unsuccessful disengagement. The study was conducted in two parts: Study I involved a purposive sample of 200 participants, whereas Study II involved a purposive sample of 500 occupationally retired older adults aged between 65 and 85 years. The constructs of the study were measured using the UDAS, Depression Anxiety and Stress Scale, and Identity and Experiences Scale. In Study I, the UDAS was subjected to an Exploratory Factor Analysis, which revealed a clear four-factor solution with high factor loadings and internally consistent factors. This factor structure was confirmed through Confirmatory Factor Analysis in Study II. Construct validity was established through the UDAS's significant positive correlation with depression and non-significant correlation with assimilation identity style. Furthermore, the mean UDAS score of older adults suffering from chronic physical ailments such as hypertension, diabetes, cardiac problems, hepatitis, ulcers, liver problems, arthritis, and joint pain was significantly higher than that of healthy older adults, indicating the concurrent validity of the UDAS in distinguishing between ill and healthy older adults. Overall, the results indicated that the UDAS was a reliable and valid instrument for measuring unsuccessful disengagement in older adults.

Tawakkul Mediates Between Personality Traits, Depression, and Anxiety in Pakistani Muslim Adults.

Tawakkul in Islam is defined as the belief in the sufficiency of Allah (God) that invokes patience and efforts to achieve goals while accepting the outcomes unconditionally. The present research intended to investigate the mediating role of tawakkul between personality traits and mental health (anxiety and depression) in a purposive sample of (N = 350) Muslim adults. Urdu versions of three instruments, namely the Tawakkul Scale (Gondal, et al., 2021), Depression, Anxiety Stress Scale of (DASS 21; Aslam, 2018), and Neuroticism-Extraversion-Openness Five-Factor Inventory (NEO-FFI; Chishti & Kamal, 2002), were used to measure the variables. Path analysis revealed that extraversion had no association with tawakkul and anxiety, but it was inversely related to depression. Neuroticism was inversely related to tawakkul and positively related to both depression and anxiety, and these relationships were partially mediated by a low degree of tawakkul. Implications of the study and recommendations for future research are discussed.

Evaluation of ChatGPT pathology knowledge using board-style questions.

OBJECTIVES: ChatGPT is an artificial intelligence chatbot developed by OpenAI. Its extensive knowledge and unique interactive capabilities enable its use in various innovative ways in the medical field, such as writing clinical notes and simplifying radiology reports. Through this study, we aimed to analyze the pathology knowledge of ChatGPT to advocate its role in transforming pathology education. METHODS: The American Society for Clinical Pathology Resident Question Bank 2022 was used to test ChatGPT, version 4. Practice tests were created in each subcategory and answered based on the input that ChatGPT provided. Questions that required interpretation of images were excluded. We analyzed ChatGPT performance and compared it with average peer performance. RESULTS: The overall performance of ChatGPT was 56.98%, lower than that of the average peer performance of 62.81%. ChatGPT performed better on clinical pathology (60.42%) than on anatomic pathology (54.94%). Furthermore, its performance was better on easy questions (68.47%) than on intermediate (52.88%) and difficult questions (37.21%). CONCLUSIONS: ChatGPT has the potential to be a valuable resource in pathology education if trained on a larger, specialized medical data set. Those relying on it (in its current form) solely for the purpose of pathology training should be cautious.

Pneumatosis intestinalis in cancer patients who received immune checkpoint inhibitors.

PURPOSE: Immune checkpoint inhibitor (ICI) therapy may give rise to immune-related adverse events (irAEs). Pneumatosis intestinalis (PI), or gas within the bowel wall, has very rarely been observed following ICI therapy, and its clinical significance is unclear. We described the clinical characteristics and outcomes of PI as a possible irAE in cancer patients. METHODS: We retrospectively identified 12 adult cancer patients with radiologic evidence of PI within 1 year after ICI exposure during January 2010-January 2023. Clinical characteristics, treatment, and outcomes were evaluated. RESULTS: The median age of our sample was 64 years. The most common cancer types were thoracic/head & neck and gastrointestinal. Eleven patients (92%) received anti-PD-1/L1 monotherapy, while 1 patient (8%) received a combination of anti-PD-1/L1 and anti-CTLA-4. PI occurred a median of 7 months after the first ICI dose. Half the patients (50%) were asymptomatic on diagnosis, and the most common presenting symptom was abdominal pain (42%). Six patients experienced complications, namely pneumoperitoneum (n = 6, 50%) and microperforation (n = 1, 8%), identified on imaging. Nine patients were treated with antibiotics and 3 patients were monitored conservatively. Nine patients (75%) resumed cancer treatment after PI. CONCLUSION: PI may develop as an irAE. While half of cases were incidental radiologic findings, management with antibiotics as well as hospitalization for observation may still be appropriate. The decision to restart cancer therapy and possibly resume ICI therapy remains to be elucidated. Further large-scale studies may be warranted to clarify the association between PI and ICI therapy.

Renal Leiomyosarcoma: Unraveling the Mysteries of a Rare Malignancy.

Primary leiomyosarcoma is a rare malignant kidney tumor. The diagnosis of this disease is usually made on the basis of histological examination because it lacks specific clinical or radiological characteristics. Differentiation between leiomyosarcoma and sarcomatoid renal cell carcinoma can be challenging because spindle cell morphology is observed in both tumors. Therefore, caution should be exercised when making a diagnosis of primary renal leiomyosarcoma. Both renal sarcoma and sarcomatoid renal cell carcinoma have a worse prognosis, and nephrectomy is the treatment of choice in locally resectable tumors. An example of such a tumor is discussed in relation to its diagnostic challenges. We report a case of a 35-year-old female who presented with a left renal mass. A left radical nephrectomy was performed, and a firm, tan-white, lobulated tumor (14x8x7.5 cm) was present on gross examination. A histological diagnosis of high-grade leiomyosarcoma was made on the basis of histology, positivity for caldesmon and desmin, and negative cytokeratin immunostaining. Sarcomatoid renal cell carcinoma was ruled out based on morphological findings after extensive sampling of the tumor along with negativity for CK, CD-10, and carbonic anhydrase IX immunostaining.

Predictive worker safety assessment through on-site correspondence using multi-layer fuzzy logic in outdoor construction environments.

Construction sites remain highly perilous work environments globally, exposing employees to numerous hazards that can result in severe injuries or fatalities. To resolve this several solutions based on quantitative approaches have been developed. However the wide adoption of preexisting solutions is hindered by lack of accuracy. To this aim the development of an efficient fuzzy inference system has become a de-facto necessity. In this paper, we propose an edge inference framework based on multi-layered fuzzy logic for safety of construction workers. The proposed system employs an edge computing-based framework where IoT devices collect, store, and manage data to offer safety services. Multi-layer fuzzy logic is applied to infer the worker safety index based on rules that consist of construction environment factors. The multi-layer fuzzy logic is fed with weather, building and worker data collected from IoT nodes as inputs. The safety risk assessment process involves analyzing various factors. Weather information, such as temperature, humidity, and rainfall data, is considered to assess the risk to safety. The condition of the building is evaluated by analyzing load, strain, and inclination data. Additionally, the safety risk to workers is analyzed by taking into account their heart rate and location information. The initial layer's outputs are utilized as inputs for the subsequent layer, where an integrated safety index is inferred. Ultimately, the safety index is generated as the final outcome. The system's results are conveyed through warnings and an error measurement on a safety scale ranging from 1 to 10. Furthermore, web service is developed to allow the construction management to check the worker safety condition of the construction site in real-time, while also monitoring the operational status of the IoT devices, allowing for the early detection of sensor malfunction and the subsequent guarantee of worker safety. Extensive evaluations conducted to test the performance of the developed framework verify its efficiency to provide improved risk assessment, real-time monitoring, and proactive safety actions, encouraging a safer and more productive work environment.

Conditional Cell Reprogramming and Air-Liquid Interface Modeling Life Cycle of Oncogenic Viruses (HPV and EBV) in Epithelial Cells and Virus-Associated Human Carcinomas.

Several oncogenic viruses are associated with approximately 20% of human cancers. Experimental models are crucial for studying the pathogenicity and biological aspects of oncogenic viruses and their potential mechanisms in tumorigenesis. Current cell models have considerable limitations such as: their low yield, genetic and epigenetic modification, and reduction in tumor heterogeneity during long propagation. Cancer cell lines are limited and not appropriate for studying the viral life cycle, for example, natural viral life cycles of HPV and EBV, and their persistence and latency in epithelial cells are poorly understood, since these processes are highly related to epithelial differentiation. Therefore, there is an urgent need of reliable human physiological cell models to study viral life cycle and cancer initiation. Conditional cell reprogramming (CCR) is a rapid and robust cell culture system, where the cells can be established from minimally invasive or noninvasive specimens and their lineage functions preserved during the long-term culture. These CR cells retain their ability to differentiate at air-liquid interface (ALI). Here, we recapitulated the applications of CR and ALI approaches in modeling host-virus interactions and viral-mediated tumorigenesis.

A New Method for Determination of Optimal Borehole Drilling Location Considering Drilling Cost Minimization and Sustainable Groundwater Management.

Drilling boreholes for the exploration of groundwater incurs high cost with potential risk of failures. However, borehole drilling should only be done in regions with a high probability of faster and easier access to water-bearing strata, so that groundwater resources can be effectively managed. However, regional strati-graphic uncertainties drive the decision of the optimal drilling location search. Unfortunately, due to the unavailability of a robust solution, most contemporary solutions rely on physical testing methods that are resource intensive. In this regard, a pilot study is conducted to determine the optimal borehole drilling location using a predictive optimization technique that takes strati-graphic uncertainties into account. The study is conducted in a localized region of the Republic of Korea using a real borehole data set. In this study we proposed an enhanced Firefly optimization algorithm based on an inertia weight approach to find an optimal location. The results of the classification and prediction model serve as an input to the optimization model to implement a well-crafted objective function. For predictive modeling a deep learning based chained multioutput prediction model is developed to predict groundwater-level and drilling depth. For classification of soil color and land-layer a weighted voting ensemble classification model based on Support Vector Machines, Gaussian Naïve Bayes, Random Forest, and Gradient Boosted Machine is developed. For weighted voting, an optimal set of weights is determined using a novel hybrid optimization algorithm. Experimental results validate the effectiveness of the proposed strategy. The proposed classification model achieved an accuracy of 93.45% and 95.34% for soil-color and land-layer, respectively. While the mean absolute error achieved by proposed prediction model for groundwater level and drilling depth is 2.89% and 3.11%, respectively. It is found that the proposed predictive optimization framework can adaptively determine the optimal borehole drilling locations for high strati-graphic uncertainty regions. The findings of the proposed study provide an opportunity to the drilling industry and groundwater boards to achieve sustainable resource management and optimal drilling performance.

Magnetic resonance imaging grading of pituitary macroadenoma - SIPAP classification revisited.

Background: Magnetic resonance imaging (MRI) is regarded as the modality of choice in diagnosis of pituitary macroadenomas. Since surgery is the first line therapy for all pituitary adenomas, simple and reproducible MRI classification based on major directions of tumour growth is an essential tool. SIPAP MRI classification for pituitary adenoma describes tumor extension in parasellar, suprasellar, infrasellar, anterior and posterior directions. We, therefore, evaluated reproducibility of SIPAP classification in reporting of pituitary adenomas. Methods: Forty-nine patients with biopsy-proven pituitary macroadenoma were graded according to SIPAP classification. Data was analyzed using Stata version 15. Interobserver variability was calculated using Cohen's Kappa. Comparison between grading before and after treatment was performed by Chi-square test. P values < 0.05 were considered statistically significant. Results: Individual tumour extensions according to SIPAP for pre- and post-operative grading showed significant difference (p-value <0.001), except for anterior extension. For suprasellar extension, 67.3 % patients had pre-operative grade-3 and 63.3 % had post-operative grade-0. For infrasellar extension, 51.0 % had pre-operative grade-2 and 71.4 % had post-operative grade-0. Anterior, posterior and parasellar extensions showed increased frequency in grade-0 in post-operative stage compared to pre-operative. Substantial inter-observer agreement was achieved for Superior, Inferior, Anterior and Posterior extent with all Kappa statistics values above 0.7 (p-value <0.001). Conclusion: We propose incorporating simple and objective SIPAP classification in routine MR reporting for ideal pituitary tumour delineation, relationship to juxtasellar structures and tumour size, hence facilitating greater success rate in surgical and subsequent clinical management.

Resilience to Self-Harm.

Background: Although a wide range of studies discuss prevalence and risk factors associated with self-harm, protective factors that are equally important are rarely explored. Moreover, much of our understanding of young individuals who engage in self-harm come from studies conducted in Western countries with very little emphasis on marginalized groups. Aim: This scoping review identifies research on resilience among marginalized youth and youth living in low- and middle-income countries (LMICs) who show evidence of self-harm. Method: A scoping review following Arksey and O'Malley's (2005) framework was conducted. This effort included drawing upon peer-reviewed research published between January 2000 and September 2020 to identify protective factors and coping strategies that are employed by individuals 10-29 years old with self-harming tendencies. Results: A total of 15 original papers met the inclusion criteria. The majority of the LMIC publications were from China. Social support, positive youth development, and religiosity were the most frequently reported protective factors. Conclusion: Despite widespread concern about self-harm, there are few peer-reviewed articles that look at resilience or recovery among youth in LMICs and among marginalized young people. In addition to various internal and external protective factors, this scoping review identifies gaps in our understanding of resilience to self-harm among youth belonging to these groups.

Efficacy and Safety of Recombinant Thrombomodulin for the Prophylaxis of Veno-Occlusive Complication in Allogeneiccit Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis.

BACKGROUND: Hepatic veno-occlusive disease (VOD), also termed as sinusoidal obstruction syndrome (SOS), is a lethal complication after hematopoietic stem cell transplantation (HSCT). Various factors put patients undergoing allogeneic HSCT at an increased risk for VOD. Thrombomodulin (TM) is an important factor which has a wide range of effects, including anticoagulant, anti-inflammatory, angiogenic, and protective effect, on endothelial cells. It plays a role in preventing excessive coagulation and thrombosis by binding with thrombin and inhibiting the coagulation cascade. There are a limited number of options for the prevention of this fatal complication. Recombinant thrombomodulin (rTM), an endothelial anticoagulant co-factor, as prophylactic therapy might be able to prevent veno-occlusive complications after stem cell transplantation. METHODS: A literature search was performed on PubMed, Embase, and Web of Science. We used the following Mesh terms and Emtree terms, "Hepatic Veno-Occlusive Diseases" OR "Sinusoidal Obstruction" OR "Stem Cell Transplantations " AND "Thrombomodulin" from the inception of data up to April 1, 2021. The PICO (Patient/Population, Intervention, Comparison and Outcomes) framework was used for the literature search. RESULTS: For the VOD incidence after HSCTstem cell transplantation, the result was in favor of rTM with a risk ratio (RR) of 0.53 (I2 = 0%, 95% confidence interval [CI] = 0.32-0.89). The incidence of transplant-associated thrombotic microangiopathy (TA-TMA) after HSCT was reduced in rTM group. The RR for incidence of TA-TMA was 0.48 (I2 = 62%, 95% CI = 0.20-1.17) favoring rTM. The RR for incidence of graft-versus-host disease (GvHD) was also lower in rTM group, 0.48 (I2 = 64%, 95% CI = 0.32-0.72). CONCLUSION: In our meta-analysis, we evaluate the efficacy and safety of rTM in the prevention of SOS after HSCT. According to our results, rTM use led to a significant reduction in SOS episodes, TA-TMA, and GvHD after HSCT.