Paediatricians' perspectives in treating lower urinary tract symptoms: a qualitative exploratory needs assessment study.

BACKGROUND: Paediatric lower urinary tract symptoms (LUTS) are common experiences among school-aged children, with prevalence rates reaching as high as 20%. Paediatricians are often first-line stakeholders in providing treatment for these bothersome symptoms, yet there is no formal resource to support them with the treatment of LUTS. Evaluating paediatricians' experiences is an important step in informing health promotion efforts to improve health outcomes in children. This study aims to explore paediatricians' knowledge, beliefs, practice patterns, and perceived barriers and facilitators in providing LUTS care. METHODS: In this qualitative study, we conducted semistructured focus groups of paediatricians within California. Focus groups were conducted via Zoom, and participants were enrolled until thematic saturation was reached. Participants were asked about their current practices, knowledge and beliefs, barriers and facilitators to care, training and education, and responsibility for behaviour and action. Thematic analysis was performed using deductive and inductive approaches; themes were mapped through an iterative, team-based process. RESULTS: 15 paediatricians, aged 30-69 years, with 13 (86.7%) women, were interviewed. Most (11, 73.3%) practised in general outpatient settings. Interviewed paediatricians recognised paediatric LUTS as a common problem that can significantly impact children's well-being. In practice, paediatricians did not actively screen for LUTS beyond the potty-training milestone due to short visit duration and competing healthcare demands. Lack of guidelines, parental mistrust and inadequate clinical education were barriers identified by paediatricians. CONCLUSIONS: Paediatricians expressed a willingness to help patients but indicated several limitations to providing adequate LUTS care. Future professional development work can emphasise guideline development, early screening strategies to support timely intervention and better education for clinicians.

Response of coastal phytoplankton to pollution from various sources in the coastal Bay of Bengal.

The coastal ocean receives nutrient pollutants from various sources, such as aerosols, municipal sewage, industrial effluents and groundwater discharge, with variable concentrations and stoichiometric ratios. The objective of this study is to examine the response of phytoplankton to these pollutants in the coastal water under silicate-rich and silicate-poor coastal waters. In order to achieve this, a microcosm experiment was conducted by adding the pollutants from various sources to the coastal waters during November and January, when the water column physicochemical characteristics are different. Low salinity and high silicate concentration were observed during November due to the influence of river discharge contrasting to that observed during January. Among the various sources of pollutants used, aerosols and industrial effluents did not contribute silicate whereas groundwater and municipal sewage contained high concentrations of silicate along with nitrate and phosphate during both the study periods. During November, an increase in phytoplankton biomass was noticed in all pollutant-added samples, except municipal sewage, due to the limitation of growth by nitrate. On the other hand, an increase in biomass and abundance of phytoplankton was observed in all pollutant-added samples, except for aerosol, during January. Increase in phytoplankton abundance associated with decrease in biomass was observed in aerosol-added sample due to co-limitation of silicate and phosphate during January. A significant response of Thalassiothrix sp. was observed for industrial effluent-added sample during November, whereas Chaetoceros sp. and Skeletonema sp. increased significantly during January. Higher increase in phytoplankton biomass was observed during November associated with higher availability of silicate in the coastal waters in January. Interestingly, an increase in the contribution of dinoflagellates was observed during January associated with low silicate in the coastal waters, suggesting that the concentration of silicate in the coastal waters determines the response of the phytoplankton group to pollutant inputs. This study suggested that silicate concentration in the coastal waters must be considered, in addition to the coastal currents, while computing dilution factors for the release of pollutants to the coastal ocean to avoid occurrence of unwanted phytoplankton blooms.

Machine learning methods in predicting the risk of malignant transformation of oral potentially malignant disorders: A systematic review.

BACKGROUND: Oral Potentially Malignant Disorders (OPMDs) refer to a heterogenous group of clinical presentations with heightened rate of malignant transformation. Identification of risk levels in OPMDs is crucial to determine the need for active intervention in high-risk patients and routine follow-up in low-risk ones. Machine learning models has shown tremendous potential in several areas of dentistry that strongly suggest its application to estimate rate of malignant transformation of precancerous lesions. METHODS: A comprehensive literature search was performed on Pubmed/MEDLINE, Web of Science, Scopus, Embase, Cochrane Library database to identify articles including machine learning models and algorithms to predict malignant transformation in OPMDs. Relevant bibliographic data, study characteristics, and outcomes were extracted for eligible studies. Quality of the included studies was assessed through the IJMEDI checklist. RESULTS: Fifteen articles were found suitable for the review as per the PECOS criteria. Amongst all studies, highest sensitivity (100%) was recorded for U-net architecture, Peaks Random forest model, and Partial least squares discriminant analysis (PLSDA). Highest specificity (100%) was noted for PLSDA. Range of overall accuracy in risk prediction was between 95.4% and 74%. CONCLUSION: Machine learning proved to be a viable tool in risk prediction, demonstrating heightened sensitivity, automation, and improved accuracy for predicting transformation of OPMDs. It presents an effective approach for incorporating multiple variables to monitor the progression of OPMDs and predict their malignant potential. However, its sensitivity to dataset characteristics necessitates the optimization of input parameters to maximize the efficiency of the classifiers.

ANN multi-layer perceptron for prediction of blood-brain barrier permeable compounds for central nervous system therapeutics.

Endothelial cells produce a semipermeable barrier known as the blood-brain barrier (BBB) to keep undesired chemicals out of the central nervous system (CNS). However, this barrier also restricts the exploration of potential new medications due to insufficient exposure. To address this challenge, machine learning (ML) algorithms can be useful to predict the BBB permeability of chemical compounds. Support vector machines, continuous neural networks, and deep learning approaches have been used to identify compounds that can penetrate the BBB. However, predicting BBB permeability based solely on chemical structure can be difficult. In the current research, we developed an ML model using a large dataset to predict BBB permeability, which could be used for early-stage drug screening of potential CNS medications. Our artificial neural network ANN algorithm exhibited an accuracy of 0.94, specificity of 0.83, sensitivity of 0.97, AUC of 0.96, and MCC of 0.83. These metrics suggest that our model has a high accuracy rate in predicting BBB permeability and therefore has the potential to advance drug discovery efforts in the CNS. This study's outcomes demonstrate the potential for ML models to predict BBB permeability accurately, aiding in the identification of new CNS therapeutic options.Communicated by Ramaswamy H. Sarma.

Efficient axonal transport of endolysosomes relies on the balanced ratio of microtubule tyrosination and detyrosination.

In neurons, the microtubule (MT) cytoskeleton forms the basis for long-distance protein transport from the cell body into and out of dendrites and axons. To maintain neuronal polarity, the axon initial segment (AIS) serves as a physical barrier, separating the axon from the somatodendritic compartment and acting as a filter for axonal cargo. Selective trafficking is further instructed by axonal enrichment of MT post-translational modifications, which affect MT dynamics and the activity of motor proteins. Here, we compared two knockout mouse lines lacking the respective enzymes for MT tyrosination and detyrosination and found that both knockouts led to a shortening of the AIS. Neurons from both lines also showed an increased immobile fraction of endolysosomes present in the axon, whereas mobile organelles displayed shortened run distances in the retrograde direction. Overall, our results highlight the importance of maintaining the balance of tyrosinated/detyrosinated MT for proper AIS length and axonal transport processes.

Enhanced Route navigation control system for turtlebot using human-assisted mobility and 3-D SLAM optimization.

An autonomous, power-assisted Turtlebot is presented in this paper in order to enhance human mobility. The turtlebot moves from its initial position to its final position at a predetermined speed and acceleration. We propose an intelligent navigation system that relies solely on individual instructions. When there is no individual present, the Turtlebot remains stationary. Turtlebot utilizes a rotating Kinect sensor in order to perceive its path. Various angles were examined in order to demonstrate the effectiveness of the system in experiments conducted on a U-shaped experimental pathway. The Turtlebot was used as an experimental device during these trials. Based on the U-shaped path, deviations from different angles were measured to evaluate its performance. SLAM (Simultaneous Localization and Mapping) experiments were also explored. We divided the SLAM problem into components and implemented the Kalman filter on the experimental path to address it. The Kalman filter focused on localization and mapping challenges, utilizing mathematical processes considering both the system's knowledge and the measurement tool. This approach allowed us to achieve the most accurate system state estimation possible. The significance of this work extends beyond the immediate application, as it lays the groundwork for advancements in wheelchair navigation research by Dynamic Control. The experiments conducted on a U-shaped pathway not only validate the efficacy of our algorithm but also provide valuable insights into the intricacies of navigating in both forward and reverse directions. These insights are pivotal for refining the navigation algorithm, ultimately contributing to the development of more robust and user-friendly systems for individuals with mobility challenges. The data used for this purpose included actuator input, vehicle location, robot movement sensors, and sensor readings representing the world state. The study provides a strong foundation for future wheelchair navigation research by Dynamic Control. Consequently, we found that navigating the Turtlebot in the reverse direction resulted in a 5%-6% increase in diversion compared to forward navigation, providing valuable insight into further improvement of the navigation algorithm.

Incidence and inhospital outcomes of coronavirus disease 2019-associated pulmonary aspergillosis in the United States.

OBJECTIVE: The aim of this study was to estimate the predictors, associations, and outcomes of COVID-19-associated pulmonary disease (CAPA) in the United States. STUDY DESIGN AND METHODS: This retrospective cohort study was performed by using the National Inpatient Sample Database 2020 to identify coronavirus disease 2019 (COVID-19) and CAPA hospitalizations. Baseline variables and outcomes were compared between COVID-19 hospitalizations without aspergillosis and those with aspergillosis. These variables were then used to perform an adjusted analysis for obtaining predictors and factors associated with CAPA and its inhospital mortality. RESULTS: Of the 1,020,880 hospitalizations identified with the principal diagnosis of COVID-19, CAPA was identified in 1510 (0.1%) hospitalizations. The CAPA cohort consisted of a higher proportion of males (58%) as well as racial and ethnic minorities (Hispanics, Blacks, and others [including Asian or Pacific islanders, native Americans]). Inhospital mortality was significantly higher (47.35% vs. 10.87%, P < 0.001), the average length of stay was longer (27.61 vs. 7.29 days, P < 0.001), and the mean cost per hospitalization was higher ($121,560 vs. $18,423, P < 0.001) in the CAPA group compared to COVID-19 without aspergillosis. History of solid organ transplant, chronic obstructive pulmonary disease, and venous thromboembolism were associated with higher odds of CAPA among other factors. The use of invasive mechanical ventilation (adjusted odds ratio [aOR] 6.24, P < 0.001), acute kidney injury (aOR 2.02, P = 0.028), and septic shock (aOR 2.07, P = 0.018) were associated with higher inhospital mortality in the CAPA cohort. CONCLUSION: While CAPA is an infrequent complication during hospitalizations for COVID-19, it significantly increases all-cause mortality, prolongs hospital stays, and leads to higher hospital expenses compared to COVID-19 cases without aspergillosis.

Avelumab in the Treatment of Advanced Merkel Cell Carcinoma: A Systematic Review.

BACKGROUND: Avelumab, a programmed death ligand-1 inhibitor, has shown success in providing durable responses for difficult-to-treat Merkel cell carcinomas (MCCs). OBJECTIVE: Evaluate the efficacy and safety of avelumab in the treatment of advanced MCC. METHODS: Studies reporting the use of avelumab as a monotherapy or in combination with other agents in the treatment of stage III or IV (advanced) MCC were included. The primary outcomes were overall response rate, overall survival (OS), and treatment-related adverse events. RESULTS: A total of 48 studies were included, involving 1,565 patients with advanced MCC. Most patients were male (1,051, 67.3%) with stage IV MCC (517, 97.0%). The overall response rate was 46.1% (partial response-25.4% and complete response-20.7%) after a mean follow-up period of 9.5 months. Kaplan-Meier survival curves for the pooled stage III and IV group demonstrated OS rates of 58% at 1 year, 47% at 2 years, and 28% at 5 years after completion of treatment with avelumab (median OS: 23.1 months). The most common treatment-related adverse events consisted of constitutional (44%), gastrointestinal (19%), and dermatologic (12%) symptoms. CONCLUSION: Avelumab monotherapy and combination therapy have shown success in the overall response rate and survival for patients with advanced MCC.

Targeting the vivid facets of apolipoproteins as a cardiovascular risk factor in rheumatoid arthritis.

Mostly, cardiovascular diseases are blamed for casualties in rheumatoid arthritis (RA) patients. Customarily, dyslipidemia is probably the most prevalent underlying cause of untimely demise in people suffering from RA as it hastens the expansion of atherosclerosis. The engagement of inflammatory cytokines like tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6), etc., is crucial in the progression and proliferation of both RA and abnormal lipid parameters. Thus, lipid abnormalities should be monitored frequently in patients with both primary and advanced RA stages. An advanced lipid profile examination, i.e., direct role of apolipoproteins associated with various lipid molecules is a more dependable approach for better understanding of the disease and selecting suitable therapeutic targets. Therefore, studying their apolipoproteins is more relevant than assessing RA patients' altered lipid profile levels. Among the various apolipoprotein classes, Apo A1 and Apo B are primarily being focused. In addition, it also addresses how calculating Apo B:Apo A1 ratio can aid in analyzing the disease's risk. The marketed therapies available to control lipid abnormalities are associated with many other risk factors. Hence, directly targeting Apo A1 and Apo B would provide a better and safer option.

A piperazine- modified Schiff base sensor for highly selective detection of Zr (IV) ions: unveiling its antioxidant potential and regulatory effects on Zea mays growth.

Piperazine functionalized Schiff bases 4(a-c) were synthesized by a condensation reaction which were thoroughly characterized by using various spectroscopic techniques like 1H NMR, 13C NMR, IR and mass spectrometry. X-ray crystallography was used to analyse synthesized compound 4b. The sensing capability of 4b was investigated towards the tetravalent form of the zirconium ion among other metal ions. The limit of detection and the association constant, were calculated to be 56.4 × 10-8 M and 5.36 × 105 M-1 respectively. The inclusion of additional metal ions had no effect on the selectivity of sensor 4b. The binding mechanism was clarified using 1HNMR spectroscopy, which was further verified computationally, using DFT. Also, the seed germination experiments were performed and effect of compound 4b was analyzed on the seedlings of Zea Mays. An investigation into molecular docking study using (5HQX) protein revealed that it had inhibitory effects on cytokinin oxidase. The protein and ligand effectively associate, as indicated by the lower binding energy of -9.69 kcal/mol. Therefore, compound 4b can act as a good, powerful inhibitor against cytokinin oxidase.

"HIV has taught us that you can survive anything": findings from auto-ethnographic video diaries exploring resilience among people living with HIV during the Covid pandemic in five countries.

This study aimed to elucidate the intrinsic and extrinsic resilience resources among people living with HIV (PLWH) during the Covid pandemic. Autoethnographic video diaries from 29 PLWH from Argentina, UK, Philippines, Zimbabwe, and Trinidad and Tobago were included. Data were thematically analysed and validated with community partners and a video was co-produced. PLWH displayed a readiness to adopt healthy behaviours and engage in optimistic and constructive thinking about the future. Hobbies and daily activities, supportive relationships with peers living with HIV, family and friends, opportunities to mobilise and contribute to their communities in meaningful ways, supportive healthcare providers and reliable access to antiretroviral treatment helped foster psychological resilience among PLWH. The extrinsic resilience resources also supported positive physical health outcomes among PLWH through improved medication adherence.

Improvements in Sperm Motility Following Low- or High-Intensity Dietary Interventions in Men With Obesity.

INTRODUCTION: Obesity increases risks of male infertility, but bariatric surgery does not improve semen quality. Recent uncontrolled studies suggest that a low-energy diet (LED) improves semen quality. Further evaluation within a randomized, controlled setting is warranted. METHODS: Men with obesity (18-60 years) with normal sperm concentration (normal count) (n = 24) or oligozoospermia (n = 43) were randomized 1:1 to either 800 kcal/day LED for 16 weeks or control, brief dietary intervention (BDI) with 16 weeks' observation. Semen parameters were compared at baseline and 16 weeks. RESULTS: Mean age of men with normal count was 39.4 ± 6.4 in BDI and 40.2 ± 9.6 years in the LED group. Mean age of men with oligozoospermia was 39.5 ± 7.5 in BDI and 37.7 ± 6.6 years in the LED group. LED caused more weight loss than BDI in men with normal count (14.4 vs 6.3 kg; P < .001) and men with oligozoospermia (17.6 vs 1.8 kg; P < .001). Compared with baseline, in men with normal count total motility (TM) increased 48 ± 17% to 60 ± 10% (P < .05) after LED, and 52 ± 8% to 61 ± 6% (P < .0001) after BDI; progressive motility (PM) increased 41 ± 16% to 53 ± 10% (P < .05) after LED, and 45 ± 8% to 54 ± 65% (P < .001) after BDI. In men with oligozoospermia compared with baseline, TM increased 35% [26] to 52% [16] (P < .05) after LED, and 43% [28] to 50% [23] (P = .0587) after BDI; PM increased 29% [23] to 46% [18] (P < .05) after LED, and 33% [25] to 44% [25] (P < .05) after BDI. No differences in postintervention TM or PM were observed between LED and BDI groups in men with normal count or oligozoospermia. CONCLUSION: LED or BDI may be sufficient to improve sperm motility in men with obesity. The effects of paternal dietary intervention on fertility outcomes requires investigation.

Experiences of embodiment during pregnancy and the postpartum period: A qualitative study.

Pregnancy and the postpartum period have been identified as times when women experience important changes in their physical bodies. Yet, little is known about the ways in which these experiences may be related to positive embodiment, or in contrast experienced as restricting and objectifying. Thus, the aim of this study was to qualitatively examine the way in which women experienced embodiment during the course of pregnancy and the postpartum period. Twenty women, mean age (SD)= 31.85, (2.3) years, 95 % White, participated in individual interviews and completed online surveys. Findings revealed that women described experiencing both aspects of positive embodiment including body connection and comfort, agency and functionality, attuned self-care, connection to appetite, and inhabiting the body as a subjective site. Findings also revealed negative aspects including body disconnection and discomfort, disrupted functionality, challenged self-care, appetite suppression, and the body as a public and objectified site. Findings highlight the potential for the pregnancy and postpartum periods to be important times for positive embodiment in women, and a source of appreciation of the body and its functionality. However, social pressures may also constrain embodiment during this period. These findings have implications for identifying pathways to positive embodiment in pregnancy and postpartum.

Accuracy of patient-reported spell duration: A comparative study.

Clinicians rely heavily on patient histories to make medical diagnoses, most of which are inherently subjective and prone to inaccuracies. The aim of this study is to compare the subjective versus objective duration of spells through a retrospective chart review of patients admitted to the epilepsy monitoring unit at our tertiary care medical center. One hundred patients were analyzed. Differences in the accuracy of subjective estimations versus objective duration were compared by age, sex, focal versus generalized, location (frontal versus non-frontal), and spell type (focal aware versus impaired awareness and epileptic versus non-epileptic). Our data show that patients are poor subjective estimators, with 73% of patients overestimating the duration of their spells. We did not find differences in estimated duration by age, sex, seizure location or spell type. A notable exception was patients with generalized convulsive seizures, who accurately reported spell duration to within 17 s. This is likely because these seizures are stereotypical, and patients/family time them. Moreover, patients with non-epileptic spells were worse estimators of their spell duration than those with epileptic spells. In addition, although the prefrontal lobe plays a role in time estimation, we did not find that patients with frontal lobe seizures were worse estimators than those with non-frontal seizures, but invasive monitoring can more precisely localize seizures within areas of the frontal lobe responsible for time estimation. Our data emphasize the importance of not relying solely on patient-reported time estimation in diagnosing and developing treatment plans and instead instructing patients to time their spells.

Sociocultural pressures and body related experiences during pregnancy and the postpartum period: A qualitative study.

Sociocultural pressures to pursue unrealistic appearance expectations and control body shape and weight during pregnancy and postpartum periods have been increasing. Little is known about messages from different sources that may constitute unhelpful or protective influences. The aim of this study was to qualitatively examine messages women received from the sociocultural environment during pregnancy and postpartum and their association with experiences of living in their bodies and body change behaviors. Twenty women, mean age (SD)= 31.85, (2.3) years, 95% White, 60% with a Master's degree or higher, participated in individual interviews and completed online surveys. Women described appearance pressure from multiple sources during and after pregnancy, that increased their concerns related to their weight and shape. For a small number, these concerns were associated with efforts to control weight. Others described protective influences from friends and family that promoted body attunement, functionality appreciation, and positive body image. Findings highlight the importance of sociocultural influences during the peripregnancy period yet how many women derive elements of positive body image from this period. These findings have implications for interventions to support body image among women during the peripregnancy period and positive outcomes among mothers and infants.

Dyschromatopsia and contrast sensitivity changes in COVID-19 patients.

PURPOSE: To evaluate the alterations in the psycho-physical tests, contrast sensitivity (CS) and hue discrimination (total estimation score, TES) in COVID-19 patients. METHODS: A prospective case-control study was undertaken in 2021-22 to look at CS and TES among COVID-19 patients and RT-PCR negative normal subjects by a mobile app "smart optometry" and X-Rite's free online version of Farnsworth-Munsell 100 hue test. Strict visual acuity (minimum of 6/9 equivalent on Snellen) and other clinical parameters were used as exclusion criteria to filter potentially confounding pre-receptoral co-morbid conditions. The effect of mismatch in recruiting age and sex matched controls during the pandemic were analyzed by multivariate linear regression. RESULT: One-way ANOVA ruled out any influence of gender on CS and TES; however, there was significant difference in the TES on Mann Whitney U test (TES- 2.95 +/- 3.8 for cases; 0.30 +/- 1.1 for controls; p <0.001) and it persisted after accounting for age. Six controls with breakthrough infections had a significant deterioration in TES (Mean scores -3.0; 95% CI = -5.89 to -0.11; p = 0.04) on paired t test. Qualitative analysis showed that S-cone mediated deficiencies outnumber those affecting M-L cone mediated deficiencies. Among 53 subjects exhibiting three sensory features, anosmia, loss of taste and dyschromatopsia, nine (16.98%) had all features concurrently. CONCLUSION: The study demonstrates that COVID-19 infection leads to altered TES representing dyschromatopsia -an ocular counterpart of anosmia, with little difference on CS.

Prognostic Value of Differential Expression of Polymerase Eta Gene in Nonresponding Patients With Diffuse Large B-cell Lymphoma.

Diffuse large B-cell lymphoma (DLBCL) represents the most common subtype of non-Hodgkins lymphoma. After the introduction of rituximab therapy like rituximab, cyclophosphamide, doxorubicin vincristine, prednisolone, there has been considerable improvement in the 5-year overall survival in this group of patients, but the nonresponding patients are a challenge to the clinician. The translesion polymerases are unique polymerases that make cells tolerant to DNA damage. Many point mutations are introduced owing to their inherent property of bypassing the points of lesions, preventing the cell from stalling replication. However, the impaired activity of these polymerases can lead to the development of tumors with aggressive clinical course. In this study, the gene expression levels of polymerase eta ( POLE ) were compared in 2 cohorts of patients with DLBCL: the first cohort, patients who had achieved complete response, and the second cohort, patients who were refractory to the treatment or had relapse within 2 years of treatment. There was a significantly upregulated expression in the refractory/relapse cohort compared with the complete remission cohort ( P = 0.0001). The high POLE expression levels correlated significantly with advanced disease stages (III and IV) and poor disease-free survival in the Kaplan-Meier curve. The high POLE expression levels were correlated with poor disease-free survival in nonresponder patients with DLBCL. The results concluded that patients with DLBCL with a high polymerase gene expression may show nonresponsiveness to chemotherapy; hence the functional impact of upregulated expression of POLE in DLBCL requires an in-depth assessment.

The Gut-Brain Connection: A Case Report on Depression in Ulcerative Colitis and Novel Treatment Approach.

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by mucosal inflammation in the colon, leading to a range of gastrointestinal symptoms. Emerging research has shown significant comorbidity between UC and depression, with a bidirectional relationship that further complicates disease management and patient well-being. Depression is more prevalent among individuals with UC, affecting 27% of them, compared to the general population's 12%. Factors contributing to depression in UC patients include the chronic nature of the disease, frequent hospitalizations, unpredictable flares, and associated physical symptoms such as pain, fatigue, and altered body image. Depression, in turn, can exacerbate UC symptoms, leading to a vicious cycle of disease progression and emotional distress. A new treatment approach has surfaced as a solution to the challenge of providing effective care to patients with UC who also suffer from depression. This approach involves a collaborative effort by a multidisciplinary team consisting of gastroenterologists, psychiatrists, psychologists, and dietitians, who work together to provide comprehensive care to UC patients with depression. This case report discussed the psychiatric presentation and management of a 75-year-old male who developed severe depression following his diagnosis of UC. This patient demonstrated significant improvement in depressive symptoms with the integrated care approach. This case highlights the importance of recognizing and addressing the psychological impact of chronic inflammatory conditions such as UC and the potential benefits of integrating psychopharmacological interventions into the treatment plan. Further research is essential to establish the effectiveness of this approach and refine its implementation in clinical practice.

Recurrent mutations in Refractory/Relapsed Diffuse Large B cell Lymphoma by targeted gene sequencing.

Introduction-Whole genome sequencing of diffuse large B-cell lymphoma [DLBCL] has identified recurrent mutations involved in pathogenesis and potentially affecting response to therapy. In this pilot study, a targeted gene panel was created to identify mutations associated with relapse/refractoriness. Material and methods- A 14-gene targeted panel was designed to sequence thirteen patients who were in remission and nine eight cases that had relapsed/refractory to treatment. A paired diagnostic biopsy and a relapse biopsy were sequenced to find genes repeatedly altered in relapse. Results- A total of 751 nonsynonymous and truncating mutations were identified. Truncated mutations in NOTCH1, TNFAIP3, and CD58 were associated with poor treatment outcomes. In cases that did not respond to treatment, a high number of mutations were found in the EZH2 gene, followed by the DNA-binding domain of TP53 and MYD88. Termination mutations in the intracellular domain of NOTCH were found in 75% of non-responsive cases. Co-occurrence of loss of function mutations of TNFAIP3 and missense mutations in MYD88 was associated with a non-responsive cohort. Discussion-The study highlights mutations associated with chemotherapeutic response in DLBCL with implications for initial diagnostic biopsy response prediction.